Regional differences in the effects of glucocorticoids on maturation of the fetal skeleton of the rat

Mid-Childhood Bone Mass After Exposure to Repeat Doses of Antenatal Glucocorticoids: A Randomized Trial

BACKGROUND AND OBJECTIVE

Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity, but could have adverse effects on skeletal development. We assessed whether exposure to repeat antenatal betamethasone alters bone mass in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids.

METHODS

Women were randomized to a single dose of betamethasone or placebo, ≥7 days after an initial course of glucocorticoids, repeated each week that they remained at risk for preterm birth at <32 weeks' gestation. In this follow-up study, children underwent whole-body dual-energy radiograph absorptiometry at 6 to 8 years' corrected age.

RESULTS

Of 212 eligible childhood survivors, 185 were studied (87%; 91 repeat betamethasone group; 94 placebo [single course] group). Children exposed to repeat antenatal betamethasone and those exposed to placebo had similar whole-body bone mineral content (median repeat betamethasone: 553 g, interquartile range: 442-712 g; placebo: 567 g, interquartile range: 447-750 g; geometric mean ratio: 0.99; 95% confidence interval: 0.94-1.03, P = .55) and bone area (median repeat betamethasone 832 cm², interquartile range: 693-963 cm²; placebo: 822 cm², interquartile range: 710-1020 cm²; geometric mean ratio: 0.99, 95% confidence interval: 0.92-1.07, P = .75).

CONCLUSIONS

Exposure to repeat doses of antenatal betamethasone compared with a single course of glucocorticoids does not alter bone mass in mid-childhood.

Rats Born to Mothers Treated with Dexamethasone 15 cH Present Changes in Modulation of Inflammatory Process

As little information about the effect of ultra high dilutions of glucocorticoid in reproduction is available in the literature, pregnant female Wistar rats (N = 12) were blindly subcutaneously treated during all gestational and lactation period with: dexamethasone 4 mg/kg diluted into dexamethasone 15 cH (mixed); or dexamethasone 4 mg/kg diluted in water; or dexamethasone 15 cH, or vehicle. Parental generation had body weight, food and water consumption monitored. The F1 generation was monitored regarding to newborn development. No birth occurred in both groups treated with dexamethasone 4 mg/kg. After 60 days from birth, 12 male F1 rats were randomly selected from each remaining group and inoculated subcutaneously with 1% carrageenan into the footpad, for evaluation of inflammatory performance. Edema and histopathology of the footpad were evaluated, using specific staining methods, immunohistochemistry and digital histomorphometry. Mothers treated with mixed dexamethasone presented reduced water consumption. F1 rats born to dexamethasone 15 cH treated females presented significant increase in mast cell degranulation, decrease in monocyte percentage, increase in CD18+ PMN cells, and early expression of ED2 protein, in relation to control. The results show that the exposure of parental generation to highly diluted dexamethasone interferes in inflammation modulation in the F1 generation.

Prenatal diagnosis and management of intrauterine fracture

Intrauterine fracture is an extremely rare finding, but can occur as the result of maternal trauma, osteogenesis imperfecta (OI), or theoretically other metabolic/structural abnormalities. Increased clinical awareness of the diagnosis and optimal management of these cases can lead to more positive outcomes for the patient and her child. Blunt abdominal trauma late in gestation increases the risk of fetal skull fracture, while a known diagnosis of OI or other abnormalities leading to decreased fetal bone density creates concern for long bone fracture. Biochemical and genetic tests can aid in the prenatal diagnosis of OI, while ultrasound is the best overall imaging modality for identifying fetal fracture of any etiology. When fetal fracture is diagnosed radiologically, specific management is recommended to promote optimal outcomes for mother and fetus, with special consideration given to the mother with OI. With the exception of fetal fractures due to lethal conditions, cesarean delivery is recommended in most cases, especially when fetal or maternal well-being cannot be assured. When a patient presents with risk factors for intrauterine fracture, careful evaluation via thorough history-taking, ultrasonography of the entire fetal skeleton, and laboratory tests should be performed. Heightened awareness of intrauterine fracture allows better postpartum management, whether for simple fracture care or for long-term care of patients with OI or genetic/metabolic abnormalities.

TARGET AUDIENCE

Obstetricians & Gynecologist, Family Physicians.

LEARNING OBJECTIVES

After completion of this educational activity, the reader will be able to compare x-ray, ultrasound modalities and MRI and their utility in diagnosing fetal fracture. Formulate a differential diagnosis for fetal fracture. Propose a delivery plan for a patient whose fetus has a prenatally diagnosed fetal fracture.

Prenatal exposure to corticosterone impairs embryonic development and increases fluctuating asymmetry in chickens (Gallus gallus domesticus)

1. The level of corticosterone in fertilised eggs from hens (Gallus gallus domesticus) was manipulated experimentally to elucidate whether stress in laying hens is harmful to the chicks, as manifested by impaired survival and reduced growth, and whether bilateral asymmetry may represent an indicator of environmental stress in poultry. 2. Three hundred and fifty eggs were randomly divided into 4 groups; 1. untreated, 2. control, 3. 10 ng corticosterone/ml and 4. 20 ng corticosterone/ml. Each of the eggs in groups 2, 3 and 4 were injected with 100 microl ethanol-saline solution (25% ethanol in saline) containing 0, 0.6 and 1.2 microg corticosterone, respectively. After the injections, the final concentration of ethanol in the egg (albumen and yolk) was 0.03%, and the concentration of added corticosterone was 0, 10 and 20 ng/ml, respectively, in groups 2, 3 and 4. All the eggs were treated on developmental d 1. 3. Corticosterone injections resulted in greater embryonic mortality, earlier termination of foetal development and reduced growth. Moreover, chicks developing in eggs with an elevated concentration of corticosterone displayed reduced developmental stability as evidenced by increased fluctuating asymmetry (FA) in tarsus length. 4. In conclusion, an increased concentration of corticosterone in the egg was detrimental to survival and growth of the chicks. Prenatal stress also generated bilateral asymmetry, and illustrates the potential application of FA as an indicator of environmental stress in poultry.

A maternal Ahr null genotype sensitizes embryos to chemical teratogenesis

The aryl hydrocarbon receptor (encoded by the Ahr locus) is a ligand-activated transcription factor that mediates the toxicology and teratology of 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin). In an effort to understand the role of the maternal compartment in dioxin teratology, we designed a breeding strategy that allowed us to compare the teratogenic response in embryos from Ahr(-/-) (null) and Ahr(+/+) (wild-type) dams. Using this strategy, we demonstrate that embryos from the Ahr(-/-) dams are 5-fold more sensitive to dioxin-induced cleft palate and hydronephrosis as compared with embryos from an Ahr(+/+) dam. Moreover, this increased teratogenic sensitivity extends beyond dioxin, because embryos from Ahr(-/-) dams exhibited a 9-fold increase in their sensitivity to the fetotoxic effects of the glucocorticoid, dexamethasone. In searching for an explanation for this increased sensitivity, we found that more dioxin and dexamethasone reached the embryos from Ahr(-/-) dams as compared with embryos from Ahr(+/+) dams. We propose that increased deposition of teratogens/fetotoxicants to the embryonic compartment is the result of porto-systemic shunting and/or blocked P4501A induction in Ahr(-/-) dams. In addition to demonstrating the importance of maternal AHR in teratogenesis, these data may have implications that reach beyond the mechanism of action of dioxin. In this regard, the Ahr(-/-) mouse may provide a system that allows pharmacological agents and toxicants to be more easily studied in a model where first pass clearance is a significant obstacle.

The effects of different steroids on costal and epiphyseal cartilage of fetal and adult rats

The effects of different doses of various steroids on growth, and on costal and epiphyseal chondrocytes, have been studied in prenatal, immature, and adult Long-Evans rats using histochemical techniques, and both light and electron microscopy. Both prenatal and postnatal treatments have been employed. The steroids used were cortisone (CA), betamethasome (BM), and, in the prenatal group only, dexamethasone (DM). Body weight is reduced in all treated rats (except the low dose of CA) by day 17 of gestation, with greater weight reductions occurring in rats receiving the higher dose level of each steroid. In rats treated prenatally or neonatally, and sacrificed postnatally on days 39-43 or days 116-127, body weights, and tibial and tail lengths, are less than in correspondingly aged controls, thus showing a persistence of the effects of treatment. Costal and epiphyseal cartilages in prenatal rats show cellular, synthetic, and ultrastructural alterations induced by treatment with glucocorticoids but the responses are not necessarily comparable. Except for the low dose of DM, the higher doses of each steroid are more effective in inhibiting, or altering, growth and cellular differentiation in the developing fetuses. Surprisingly, a low dose of DM has a more devastating effect on the cells and extracellular matrix of both costal and epiphyseal cartilage, than do higher dose-levels of the various steroids. Low doses of CA and BM are also effective in inhibiting or altering growth and cellular differentiation, but their effectiveness is largely limited to 17 days of gestation. The order of effect of the various doses of the different steroids on fetal cartilage, listed in decreasing order of severity, is as follows: 0.12 DM, 0.24 DM, 0.42 BM, 50 CA, with 25 CA and 0.18 BM being approximately equal and only slightly different from control cartilages. The effect of prenatal or neonatal glucocorticoid treatment on chondrocytes is minimal in the 30-43 days, or 116-127 day, postnatal groups. In immature and adult rats, cortisone affects the chondrocytes more deleteriously than does betamethasone, and a 5.0 mg dose of CA seems to affect chondrocytes, body weight, and tibial and tail lengths more than 0.2 or 7.5 mg doses.

The effect of prenatal protein-energy malnutrition on the development of mandibles and long bones in newborn rats

To evaluate the role of gestational protein-energy malnutrition on fetal hard-tissue growth and metabolism, we measured several variables in the growth centres of mandibles and long bones of newborn rats. Control pups and pups of malnourished dams had approximately the same extent of reduction in body-weight, mandibular weight and long-bone weight. The malnourished group had more cells in the mandible although cell size was the same as that of controls. In contrast, in the long bones, the malnourished group had fewer cells than did controls whereas cell size was unchanged. Calcium content was the same in long bones of both groups, but was less in the mandibles of pups from malnourished dams. Ca metabolism as measured by 45Ca uptake was unchanged in the long bones, but was increased in the mandibles of the malnourished group shortly after birth. Calcification patterns at birth in these bones correlated well with alkaline phosphatase (EC 3.1.3.1) activity. These findings indicate that the mandibles and long bones of offspring are affected differently by protein-energy malnutrition during the mother's gestation. Prenatal nutritional stress resulted in a disturbance of the pituitary-adrenal system. Increased adrenal corticosterone could possibly be related to the different observed changes in bone metabolism.