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Navalón P, Campos-Berga L, Buesa J, Lizarán M, Ghosn F, Almansa B, Moreno-Giménez A, Vento M, Diago V, García-Blanco A. Rescue doses of antenatal corticosteroids, children's neurodevelopment, and salivary cortisol after a threatened preterm labor: a 30-month follow-up study. Am J Obstet Gynecol MFM 2023; 5:100918. [PMID: 36882125 DOI: 10.1016/j.ajogmf.2023.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Antenatal corticosteroids reduce neonatal complications when administered to women at risk for preterm birth. Moreover, antenatal corticosteroid rescue doses are recommended for women who remain at risk after the initial course. However, there is controversy about the most appropriate frequency and the exact timing of administering additional antenatal corticosteroid doses because there are potential long-term negative effects on infants' neurodevelopment and physiological stress functioning. OBJECTIVE This study aimed to (1) to assess the long-term neurodevelopmental effects of receiving antenatal corticosteroid rescue doses in comparison with receiving only the initial course; (2) to measure the cortisol levels of infants of mothers who received antenatal corticosteroid rescue doses; (3) to examine a potential dose-response effect of the number of antenatal corticosteroid rescue doses on children's neurodevelopment and salivary cortisol. STUDY DESIGN This study followed 110 mother-infant pairs who underwent a spontaneous episode of threatened preterm labor until the children were 30 months old, regardless of their gestational age at birth. Among the participants, 61 received only the initial course of corticosteroids (no rescue dose group), and 49 participants required at least one rescue dose of corticosteroids (rescue doses group). The follow-up was carried out at 3 different times, namely at threatened preterm labor diagnosis (T1), when the children were 6 months of age (T2), and when the children were 30 months of corrected age for prematurity (T3). Neurodevelopment was assessed using the Ages & Stages Questionnaires, Third Edition. Saliva samples were collected for cortisol level determination. RESULTS First, the rescue doses group showed lower problem-solving skills at 30 months of age than the no rescue doses group. Second, the rescue doses group demonstrated higher salivary cortisol levels at 30 months of age. Third, a dose-response effect was found that indicated that the more rescue doses the rescue doses group received, the lower the problem-solving skills and the higher the salivary cortisol levels at 30 months of age. CONCLUSION Our findings reinforce the hypothesis that additional antenatal corticosteroid doses provided after the initial course may have long-term effects on the neurodevelopment and glucocorticoid metabolism of the offspring. In this regard, the results raise concerns about the negative effects of repeated doses of antenatal corticosteroids in addition to a full course. Further studies are necessary to confirm this hypothesis to help physicians reassess the standard antenatal corticosteroid treatment regimens.
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Affiliation(s)
- Pablo Navalón
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Drs Navalón, Campos-Berga, Buesa, and García-Blanco)
| | - Laura Campos-Berga
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Drs Navalón, Campos-Berga, Buesa, and García-Blanco)
| | - Julia Buesa
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Drs Navalón, Campos-Berga, Buesa, and García-Blanco)
| | - Marta Lizarán
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain (Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez and Dr García-Blanco)
| | - Farah Ghosn
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain (Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez and Dr García-Blanco)
| | - Belén Almansa
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain (Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez and Dr García-Blanco)
| | - Alba Moreno-Giménez
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain (Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez and Dr García-Blanco)
| | - Máximo Vento
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Vento)
| | - Vicente Diago
- Division of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Diago)
| | - Ana García-Blanco
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain (Drs Navalón, Campos-Berga, and Buesa, Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez, and Drs Vento and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Drs Navalón, Campos-Berga, Buesa, and García-Blanco); Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain (Mses Lizarán, Ghosn, Almansa, and Moreno-Giménez and Dr García-Blanco).
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Varner MW, Costantine MM, Jablonski KA, Rouse DJ, Mercer BM, Leveno KJ, Reddy UM, Buhimschi C, Wapner RJ, Sorokin Y, Thorp JM, Ramin SM, Malone FD, Carpenter M, O’sullivan MJ, Peaceman AM, Dudley DJ, Caritis SN. Sex-Specific Genetic Susceptibility to Adverse Neurodevelopmental Outcome in Offspring of Pregnancies at Risk of Early Preterm Delivery. Am J Perinatol 2020; 37:281-290. [PMID: 30731481 PMCID: PMC6685763 DOI: 10.1055/s-0039-1678535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate sex-specific genetic susceptibility to adverse neurodevelopmental outcome (ANO, defined as cerebral palsy [CP], mental, or psychomotor delay) at risk for early preterm birth (EPTB, < 32 weeks). STUDY DESIGN Secondary case-control analysis of a trial of magnesium sulfate (MgSO4) before anticipated EPTB for CP prevention. Cases are infants who died by the age of 1 year or developed ANO. Controls, matched by maternal race and infant sex, were neurodevelopmentally normal survivors. Neonatal DNA was evaluated for 80 polymorphisms in inflammation, coagulation, vasoregulation, excitotoxicity, and oxidative stress pathways using Taqman assays. The primary outcome for this analysis was sex-specific ANO susceptibility. Conditional logistic regression estimated each polymorphism's odds ratio (OR) by sex stratum, adjusting for gestational age, maternal education, and MgSO4-corticosteroid exposures. Holm-Bonferroni corrections, adjusting for multiple comparisons (p < 7.3 × 10-4), accounted for linkage disequilibrium between markers. RESULTS Analysis included 211 cases (134 males; 77 females) and 213 controls (130 males; 83 females). An interleukin-6 (IL6) polymorphism (rs2069840) was associated with ANO in females (OR: 2.6, 95% confidence interval [CI]: 1.5-4.7; p = 0.001), but not in males (OR: 0.8, 95% CI: 0.5-1.2; p = 0.33). The sex-specific effect difference was significant (p = 7.0 × 10-4) and was unaffected by MgSO4 exposure. No other gene-sex associations were significant. CONCLUSION An IL6 gene locus may confer susceptibility to ANO in females, but not males, after EPTB.
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Affiliation(s)
- Michael W. Varner
- Department of Obstetrics and Gynecology, University of
Utah, Salt Lake City, Utah
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, University of
Texas Medical Branch, Galveston, Texas
| | - Kathleen A. Jablonski
- Department of Epidemiology and Biostatistics, George
Washington University Biostatistics Center, Washington, Disctrict of Columbia
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, University of
Alabama at Birmingham, Birmingham, Alabama
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, MetroHealth
Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth J. Leveno
- Department of Obstetrics and Gynecology, University of
Texas Southwestern Medical Center, Dallas, Texas
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health
and Human Development, Bethesda, Maryland
| | - Catalin Buhimschi
- Department of Obstetrics and Gynecology, The Ohio State
University, Columbus, Ohio
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Thomas Jefferson
University, Philadelphia, Pennsylvania
- Department of Obstetrics and Gynecology, Drexel
University, Philadelphia, Pennsylvania
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State
University, Detroit, Michigan
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of
North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan M. Ramin
- Department of Obstetrics and Gynecology, University of
Texas Health Science Center at Houston, Houston, Texas
| | - Fergal D. Malone
- Department of Obstetrics and Gynecology, Columbia
University, New York, New York
| | - Marshall Carpenter
- Department of Obstetrics and Gynecology, Brown
University, Providence, Rhode Island
| | - Mary J. O’sullivan
- Department of Obstetrics and Gynecology, University of
Miami, Miami, Florida
| | - Alan M. Peaceman
- Department of Obstetrics and Gynecology, Northwestern
University, Chicago, Illinois
| | - Donald J. Dudley
- Department of Obstetrics and Gynecology, University of
Texas Health Science Center, San Antonio, Texas
| | - Steve N. Caritis
- Department of Obstetrics and Gynecology, University of
Pittsburgh, Pittsburgh, Pennsylvania
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