1
|
Chawanpaiboon S, Chukaew R, Pooliam J. A comparison of 2 doses of antenatal dexamethasone for the prevention of respiratory distress syndrome: an open-label, noninferiority, pragmatic randomized trial. Am J Obstet Gynecol 2024; 230:260.e1-260.e19. [PMID: 37442247 DOI: 10.1016/j.ajog.2023.07.006] [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: 02/26/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Antenatal corticosteroids have been used for the prevention of respiratory complications, intraventricular hemorrhage, necrotizing enterocolitis, and other adverse neonatal outcomes for over 50 years, with limited evidence about their optimal doses. Higher steroid doses or frequencies of antenatal corticosteroids in preterm newborns pose adverse effects such as prolonged adrenal suppression, negative effects on fetal programming and metabolism, and increased risks of neurodevelopmental and neuropsychological impairments. Conversely, lower doses of antenatal corticosteroids may be an effective alternative to induce fetal lung maturation with less risk to the fetus. Late preterm births represent the largest population of all preterm neonates, with a respiratory distress syndrome risk of 8.83%. Therefore, determining the optimal antenatal corticosteroid dosage is of particular importance for this population. OBJECTIVE This study aimed to compare the efficacy of 5-mg and 6-mg dexamethasone in preventing neonatal respiratory distress syndrome in women with preterm births at 320 to 366 weeks of gestation. STUDY DESIGN This was an open-label, randomized, controlled, noninferiority trial. Singleton pregnant women (n=370) at 320 to 366 weeks of gestation with spontaneous preterm labor or preterm premature rupture of membranes were enrolled. They were randomly assigned (1:1) to a 5-mg or 6-mg dexamethasone group. Dexamethasone was administered intramuscularly every 12 hours for 4 doses or until delivery. The primary outcome was the reduction in neonatal respiratory distress syndrome cases, whereas the secondary outcomes were any adverse maternal or neonatal events. RESULTS Between December 2020 and April 2022, 370 eligible women, anticipating deliveries within the gestational range of 32 0/7 to 36 6/7 weeks, willingly participated in the study. They were evenly split, with 185 women assigned to the 5-mg group and 185 to the 6-mg group. The study revealed that the demographic profiles of the participants in the 2 groups were remarkably similar, with no statistically significant disparities (P>.05). It is noteworthy that most of these women gave birth after 34 weeks of gestation. Despite a substantial proportion not completing the full course of steroid treatment, the 5-mg dose exhibited noninferiority compared with the 6-mg dose of dexamethasone, as indicated by a modest proportional difference of 0.5% (95% confidence interval, -2.8 to 43.9). Neonatal respiratory distress syndrome occurred in a relatively low percentage of newborns in both groups, affecting 2.2% in the 5-mg group and 1.6% in the 6-mg group. Notably, the risk difference of 0.6% fell comfortably within the predefined noninferiority threshold of 10%. CONCLUSION Our study suggests that a 5-mg dexamethasone dose is noninferior to a standard 6-mg dose in preventing neonatal respiratory distress syndrome in preterm births.
Collapse
Affiliation(s)
- Saifon Chawanpaiboon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Ronnakorn Chukaew
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiological Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Freuer D, Meisinger C. Causal effects of time-varying body size on selected autoimmune disorders: a life course Mendelian randomisation study. RMD Open 2023; 9:e003633. [PMID: 37963678 PMCID: PMC10649873 DOI: 10.1136/rmdopen-2023-003633] [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: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Based on Barker's hypothesis, some studies investigated the associations between birth weight and several disorders. Apart from issues with statistical power and well-known shortcomings of the observational study design, there are no studies accounting for changes in weight-related body size over the life course regarding rheumatoid arthritis, psoriasis, psoriatic arthritis and multiple sclerosis. METHODS Using genetic information of up to 806 834 participants, this study investigated the associations between time-varying weight-related body size from birth to adulthood and the mentioned autoimmune diseases. Performing Mendelian randomisation (MR), the radial inverse-variance weighted approach was used iteratively in primary analyses. Robustness of the results was confirmed in several sensitivity analyses. Potential time-dependent mediation mechanisms were identified through network-clustering and assessed using multivariable MR. RESULTS Genetically predicted birth weight (fetal effect) was positively associated with rheumatoid arthritis (OR 1.44; 95% CI 1.17 to 1.77; Padj =0.005) but not with psoriasis, psoriatic arthritis or multiple sclerosis. This association was found to be mediated by body mass index (BMI) in adulthood (OR 1.45; 95% CI 1.14 to 1.84; Padj =0.019) rather than childhood. The direct effect of birth weight attenuated (OR 1.19; 95% CI 0.88 to 1.62); Padj =1) after adjustment for time-varying BMI. CONCLUSION Increased birth weight appears to be a risk factor for later manifestation of rheumatoid arthritis due to both fetal genetic components and high BMI persisting into adulthood. Approaches to prevent and minimise the risk of rheumatoid arthritis could include preventing obesity in adults with high birth weight.
Collapse
Affiliation(s)
- Dennis Freuer
- Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Epidemiology, Medical Faculty, University of Augsburg, University Hospital of Augsburg, Augsburg, Germany
| |
Collapse
|
3
|
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.
Collapse
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).
| |
Collapse
|
4
|
Tenbrink E, Quain A, Rone V, Harris K, Hadley E, Haas D, Shanks A. Risk of Neonatal Sepsis With Rescue Steroids in Preterm Premature Rupture of Membranes. Cureus 2023; 15:e37207. [PMID: 37159785 PMCID: PMC10163895 DOI: 10.7759/cureus.37207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/11/2023] Open
Abstract
Objective To evaluate whether a rescue course of corticosteroids, when given at least 14 days after the initial course, is associated with an increased risk of neonatal sepsis after preterm premature rupture of membranes (PPROM). Methods We performed a retrospective, descriptive cohort study of women with singleton gestations from 23+0 to 34+0 weeks of gestation who received a rescue course of corticosteroids within the Indiana University Health Network from January 2009 through October 2016. Patients were separated into three groups based on amniotic membrane status at the time of each corticosteroid administration: Group 1 (intact membranes at initial/intact membranes at rescue), Group 2 (intact membranes at initial/PPROM at rescue), and Group 3 (PPROM at initial/PPROM at rescue). The primary outcome (neonatal sepsis) was compared between the groups. Patient characteristics and neonatal outcomes were analyzed with Fisher's exact test for categorical variables and ANOVA for continuous variables. Relative risk (RR) was calculated by comparing those with ruptured membranes to those with intact membranes at the time of rescue course administration. Results A total of 143 patients were eligible. Neonatal sepsis occurred in 6.8% of patients in Group 1, 21.1% of patients in Group 2, and 23.8% of patients in Group 3. Groups 2 and 3 had a statistically significant higher rate of neonatal sepsis than Group 1 (p = 0.021). The RR of neonatal sepsis after a rescue course in patients with PPROM (Groups 2 and 3) was 3.31 (95% CI = 1.32, 8.29) compared to those with intact membranes at the time of rescue course administration (Group 1). Conclusion A rescue course of corticosteroids in women with PPROM at the time of rescue administration was associated with an increased risk of neonatal sepsis. This increased risk was seen in women with intact membranes as well as ruptured membranes during their initial course of steroids. Larger studies are needed to further investigate this association.
Collapse
Affiliation(s)
- Emily Tenbrink
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
| | - Angela Quain
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
| | - Victoria Rone
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
| | - Kate Harris
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
| | - Emily Hadley
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
| | - David Haas
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
| | - Anthony Shanks
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA
| |
Collapse
|
5
|
Filippini C, Saran S, Chari B. Musculoskeletal steroid injections in pregnancy: a review. Skeletal Radiol 2023:10.1007/s00256-023-04320-9. [PMID: 36917270 DOI: 10.1007/s00256-023-04320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.
Collapse
Affiliation(s)
- Claire Filippini
- Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK
| | - Sonal Saran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Basavaraj Chari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
| |
Collapse
|
6
|
Cowell W, Kloog I, Just AC, Coull BA, Carroll K, Wright RJ. Ambient PM 2.5 exposure and salivary cortisol output during pregnancy in a multi-ethnic urban sample. Inhal Toxicol 2023; 35:101-108. [PMID: 35312378 PMCID: PMC10264094 DOI: 10.1080/08958378.2022.2051647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/05/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Evidence from murine research supports that fine particulate matter (PM2.5) may stimulate the hypothalamic-pituitary-adrenal axis, leading to elevated circulating glucocorticoid levels. Epidemiologic research examining parallel associations document similar associations. We examined these associations among a diverse sample of pregnant individuals exposed to lower levels of ambient PM2.5. MATERIALS AND METHODS Participants included pregnant individuals enrolled in the PRogramming of Intergenerational Stress Mechanisms (PRISM) pre-birth cohort. Daily residential PM2.5 exposure was estimated using a satellite-based spatial-temporal hybrid model. Maternal 3rd trimester salivary cortisol levels were used to calculate several features of the diurnal cortisol rhythm. We used multivariable linear regression to examine PM2.5 during the pre-conception period and during each trimester in relation to cortisol awakening rise (CAR), slope, and area under the curve relative to ground (AUCG). RESULTS AND DISCUSSION The average PM2.5 exposure level across pregnancy was 8.13 µg/m3. PM2.5 in each exposure period was positively associated with AUCG, a measure of total cortisol output across the day. We also observed an inverse association between PM2.5 in the 3rd trimester and diurnal slope, indicating a steeper decline in cortisol throughout the day with increasing exposure. We did not detect strong associations between PM2.5 and slope for the other exposure periods or between PM2.5 and CAR for any exposure period. CONCLUSIONS In this sample, PM2.5 exposure across the preconception and pregnancy periods was associated with increased cortisol output, even at levels below the U.S. National Ambient Air Quality Annual Standard for PM2.5 of 12.0 µg/m3.
Collapse
Affiliation(s)
- Whitney Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Itai Kloog
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Allan C. Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Brent A. Coull
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA
| | - Kecia Carroll
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| |
Collapse
|
7
|
Mlili NE, Ahabrach H, Cauli O. Hair Cortisol Concentration as a Biomarker of Symptoms of Depression in the Perinatal Period. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:71-83. [PMID: 35297354 DOI: 10.2174/1871527321666220316122605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022]
Abstract
Pregnancy is a sensitive period when women experience major hormonal and psychological changes. A high prevalence of the symptoms of depression and manifested major depression rates have been reported during this period, leading to negative outcomes both for mothers and the offspring. Despite its prevalence, the aetiology of depression is not yet fully understood. Nonetheless, alterations in cortisol levels have been proposed as a reliable biomarker to identify pregnant women at risk of perinatal depression. Hair cortisol has recently been extensively used in bio-psychological studies as a suitable non-invasive biomarker for several neuropsychiatric disorders. Various studies have published evidence regarding the relationship between cortisol fluctuations during the perinatal period, measured both in hair and in other substrates, and the onset of perinatal symptoms of depression. This current review provides an overview of cortisol level changes measured in women's hair during pregnancy or the postpartum period and its association with perinatal symptoms of depression. Further studies, including repetitive measurement of both hair cortisol and depression throughout the prenatal period, must be performed to clarify the relationship between cortisol levels and perinatal symptoms of depression.
Collapse
Affiliation(s)
- Nisrin El Mlili
- Institut Supérieur des Professions Infirmières et Techniques de Santé (ISPITS), Tetouan, Morocco
- Department of Physiology and Physiopathology, Faculty of Sciences, University Abdelmalek Essâadi, Tetouan, Morocco
| | - Hanan Ahabrach
- Institut Supérieur des Professions Infirmières et Techniques de Santé (ISPITS), Tetouan, Morocco
- Department of Physiology and Physiopathology, Faculty of Sciences, University Abdelmalek Essâadi, Tetouan, Morocco
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia 46010, Spain
- Frailty and Cognitive Impairment Group (FROG), University of Valencia, Valencia 46010, Spain
| |
Collapse
|
8
|
Chawanpaiboon S, Pooliam J, Chuchotiros M. A case-control study on the effects of incomplete, one, and more than one dexamethasone course on acute respiratory problems in preterm neonates born between 28 0 and 36 6 weeks of gestation. BMC Pregnancy Childbirth 2022; 22:880. [PMID: 36443697 PMCID: PMC9703789 DOI: 10.1186/s12884-022-05209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare the effects of an incomplete course and more than 1 course of dexamethasone, relative to a control of a single complete course, on foetal respiratory problems and other adverse outcomes of preterm birth. METHODS This was a retrospective chart review of 1800 women with preterm delivery. Data were collected on newborns whose mothers administered 1 full course of dexamethasone (916/1800; 50.9%), a partial course (716/1800; 39.8%) and more than 1 course (168/1800; 9.3%). Demographic data and adverse maternal and neonatal outcomes were recorded. RESULTS Preterm singleton newborns whose mothers received several steroid hormone courses were significantly more likely to have adverse outcomes than newborns of mothers given 1 course. The negative outcomes were the need for positive pressure ventilation ([aOR] 1.831; 95% CI, (1.185,2.829); P = 0.019), ventilator support ([aOR] 1.843; 95% CI, (1.187,2.861); P = 0.011), and phototherapy ([aOR] 1.997; 95% CI, (1.378,2.895); P < 0.001), transient tachypnoea of the newborn ([aOR] 1.801; 95% CI, (1.261,2.571); P = 0.002), intraventricular haemorrhage ([aOR] 2.215; 95% CI, (1.159, 4.233); P = 0.027), sepsis ([aOR] 1.737; 95% CI, (1.086, 2.777); P = 0.007), and admission to neonatal intensive care ([aOR] 1.822; 95% CI, (1.275,2.604); P = 0.001). In the group of very preterm infants, newborns of mothers administered an incomplete course had developed respiratory distress syndrome (RDS) ([aOR] 3.177; 95% CI, (1.485, 6.795); P = 0.006) and used ventilatory support ([aOR] 3.565; 95% CI, (1.912, 6.650); P < 0.001) more than those of mothers receiving a single course. CONCLUSIONS Preterm singleton newborns whose mothers were given multiple courses of dexamethasone had an increased incidence of RDS and other adverse outcomes than those of mothers receiving a full course. However, very preterm newborns whose mothers were administered 1 full dexamethasone course had a significantly lower incidence of RDS than those whose mothers were given partial courses.
Collapse
Affiliation(s)
- Saifon Chawanpaiboon
- grid.10223.320000 0004 1937 0490Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
| | - Julaporn Pooliam
- grid.10223.320000 0004 1937 0490Clinical Epidemiological Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
| | - Monsak Chuchotiros
- grid.10223.320000 0004 1937 0490Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
| |
Collapse
|
9
|
Navalón P, Ghosn F, Ferrín M, Almansa B, Moreno-Giménez A, Campos-Berga L, Sahuquillo-Leal R, Diago V, Vento M, García-Blanco A. Are infants born after an episode of suspected preterm labor at risk of attention deficit hyperactivity disorder? A 30-month follow-up study. Am J Obstet Gynecol 2022; 227:757.e1-757.e11. [PMID: 35671781 DOI: 10.1016/j.ajog.2022.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND An episode of suspected preterm labor may be by itself a pathologic event that may alter the normal course of pregnancy and the offspring's neurodevelopment. Certainly, the association between preterm birth and neurodevelopmental disorders can only be partially explained by the immaturity of the nervous system, as evidenced by the increased risk of attention deficit hyperactivity disorder in late-preterm infants without any neurologic alteration. OBJECTIVE This study aimed to examine whether infants born after suspected preterm labor may be at an increased risk of developing attention deficit hyperactivity disorder. Moreover, potential obstetrical, perinatal, and psychosocial risk factors associated with attention deficit hyperactivity disorder in this population are examined. STUDY DESIGN A prospective cohort study of 120 mother-infant pairs was conducted from the moment the mothers received a diagnosis of suspected preterm labor until the infants' 30 months of life. Infants were divided according to the prematurity status: full-term infants born after a suspected preterm labor (n=28; born at ≥37 weeks of gestation), late-preterm infants (n=56; born between 32 and <37 weeks of gestation), very-preterm infants (n=36; born before <32 weeks of gestation). At-term infants born without obstetric complications served as a control group (n=46). Infants' attention deficit hyperactivity disorder symptoms were assessed at the age of 30 months. Furthermore, obstetrical, perinatal, and psychosocial risk factors were recorded. RESULTS All groups of infants born after a suspected preterm labor showed more attention deficit hyperactivity disorder symptoms at the age of 30 months than the control group. Concretely, very-preterm infants showed higher restless or impulsive behaviors, whereas full-term infants born after a suspected preterm labor and late-preterm infants showed higher emotional lability behaviors. Among potential risk factors, male sex and maternal experience of posttraumatic stress symptoms predicted the severity of attention deficit hyperactivity disorder symptoms in infants born after a suspected preterm labor. CONCLUSION Infants born after a suspected preterm labor had a higher risk of developing attention deficit hyperactivity disorder symptoms, including those born at term. Infants born after a suspected preterm labor showed a distinctive phenotype and shared specific risk factors suggesting that they conform an undescribed population at risk of attention deficit hyperactivity disorder.
Collapse
Affiliation(s)
- Pablo Navalón
- Neonatal Research Group, La Fe Health Research Institute (Instituto de Investigación Sanitaria La Fe), Valencia, Spain; Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Farah Ghosn
- Neonatal Research Group, La Fe Health Research Institute (Instituto de Investigación Sanitaria La Fe), Valencia, Spain; Faculty of Psychology, Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Maite Ferrín
- Haringey Children and Adolescent Mental Health Service, National Health Service, London, United Kingdom; Re:Cognition Health, London, United Kingdom
| | - Belén Almansa
- Neonatal Research Group, La Fe Health Research Institute (Instituto de Investigación Sanitaria La Fe), Valencia, Spain; Faculty of Psychology, Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Alba Moreno-Giménez
- Neonatal Research Group, La Fe Health Research Institute (Instituto de Investigación Sanitaria La Fe), Valencia, Spain; Faculty of Psychology, Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Laura Campos-Berga
- Neonatal Research Group, La Fe Health Research Institute (Instituto de Investigación Sanitaria La Fe), Valencia, Spain; Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Rosa Sahuquillo-Leal
- Faculty of Psychology, Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Vicente Diago
- Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Máximo Vento
- Neonatal Research Group, La Fe Health Research Institute (Instituto de Investigación Sanitaria La Fe), Valencia, Spain; Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ana García-Blanco
- Neonatal Research Group, La Fe Health Research Institute (Instituto de Investigación Sanitaria La Fe), Valencia, Spain; Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain; Faculty of Psychology, Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain.
| |
Collapse
|
10
|
Hong JY. Developmental Programming by Perinatal Glucocorticoids. Mol Cells 2022; 45:685-691. [PMID: 36254710 PMCID: PMC9589377 DOI: 10.14348/molcells.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/29/2022] [Accepted: 06/15/2022] [Indexed: 11/07/2022] Open
Abstract
Early-life environmental factors can have persistent effects on physiological functions by altering developmental procedures in various organisms. Recent experimental and epidemiological studies now further support the idea that developmental programming is also present in mammals, including humans, influencing long-term health. Although the mechanism of programming is still largely under investigation, the role of endocrine glucocorticoids in developmental programming is gaining interest. Studies found that perinatal glucocorticoids have a persistent effect on multiple functions of the body, including metabolic, behavioral, and immune functions, in adulthood. Several mechanisms have been proposed to play a role in long-term programming. In this review, recent findings on this topic are summarized and the potential biological rationale behind this phenomenon is discussed.
Collapse
Affiliation(s)
- Jun Young Hong
- Department of Systems Biology, College of Life Science and Biotechnology, Yonsei University, Seoul 03722, Korea
| |
Collapse
|
11
|
Schmitz T, Doret-Dion M, Sentilhes L, Parant O, Claris O, Renesme L, Abbal J, Girault A, Torchin H, Houllier M, Le Saché N, Vivanti AJ, De Luca D, Winer N, Flamant C, Thuillier C, Boileau P, Blanc J, Brevaut V, Bouet PE, Gascoin G, Beucher G, Datin-Dorriere V, Bounan S, Bolot P, Poncelet C, Alberti C, Ursino M, Aupiais C, Baud O. Neonatal outcomes for women at risk of preterm delivery given half dose versus full dose of antenatal betamethasone: a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial. Lancet 2022; 400:592-604. [PMID: 35988568 DOI: 10.1016/s0140-6736(22)01535-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Antenatal betamethasone is recommended before preterm delivery to accelerate fetal lung maturation. However, reports of growth and neurodevelopmental dose-related side-effects suggest that the current dose (12 mg plus 12 mg, 24 h apart) might be too high. We therefore investigated whether a half dose would be non-inferior to the current full dose for preventing respiratory distress syndrome. METHODS We designed a randomised, multicentre, double-blind, placebo-controlled, non-inferiority trial in 37 level 3 referral perinatal centres in France. Eligible participants were pregnant women aged 18 years or older with a singleton fetus at risk of preterm delivery and already treated with the first injection of antenatal betamethasone (11·4 mg) before 32 weeks' gestation. We used a computer-generated code producing permuted blocks of varying sizes to randomly assign (1:1) women to receive either a placebo (half-dose group) or a second 11·4 mg betamethasone injection (full-dose group) 24 h later. Randomisation was stratified by gestational age (before or after 28 weeks). Participants, clinicians, and study staff were masked to the treatment allocation. The primary outcome was the need for exogenous intratracheal surfactant within 48 h after birth. Non-inferiority would be shown if the higher limit of the 95% CI for the between-group difference between the half-dose and full-dose groups in the primary endpoint was less than 4 percentage points (corresponding to a maximum relative risk of 1·20). Four interim analyses monitoring the primary and the secondary safety outcomes were done during the study period, using a sequential data analysis method that provided futility and non-inferiority stopping rules and checked for type I and II errors. Interim analyses were done in the intention-to-treat population. This trial was registered with ClinicalTrials.gov, NCT02897076. FINDINGS Between Jan 2, 2017, and Oct 9, 2019, 3244 women were randomly assigned to the half-dose (n=1620 [49·9%]) or the full-dose group (n=1624 [50·1%]); 48 women withdrew consent, 30 fetuses were stillborn, 16 neonates were lost to follow-up, and 9 neonates died before evaluation, so that 3141 neonates remained for analysis. In the intention-to-treat analysis, the primary outcome occurred in 313 (20·0%) of 1567 neonates in the half-dose group and 276 (17·5%) of 1574 neonates in the full-dose group (risk difference 2·4%, 95% CI -0·3 to 5·2); thus non-inferiority was not shown. The per-protocol analysis also did not show non-inferiority (risk difference 2·2%, 95% CI -0·6 to 5·1). No between-group differences appeared in the rates of neonatal death, grade 3-4 intraventricular haemorrhage, stage ≥2 necrotising enterocolitis, severe retinopathy of prematurity, or bronchopulmonary dysplasia. INTERPRETATION Because non-inferiority of the half-dose compared with the full-dose regimen was not shown, our results do not support practice changes towards antenatal betamethasone dose reduction. FUNDING French Ministry of Health.
Collapse
Affiliation(s)
- Thomas Schmitz
- Department of Obstetrics and Gynaecology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Centre for Research in Epidemiology and Statistics, INSERM U1153, INRA, Paris, France.
| | - Muriel Doret-Dion
- Department of Obstetrics and Gynaecology, Hospital Femme-Mère-Enfant, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | - Loic Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Parant
- Department of Obstetrics and Gynaecology, Toulouse University Hospital, Toulouse, France
| | - Olivier Claris
- Department of Neonatology, Hospital Femme-Mère-Enfant, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | - Laurent Renesme
- Department of Neonatology, Bordeaux University Hospital, Bordeaux, France
| | - Julie Abbal
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Aude Girault
- Université Paris Cité, Centre for Research in Epidemiology and Statistics, INSERM U1153, INRA, Paris, France; MaternitéPort-Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Héloïse Torchin
- Université Paris Cité, Centre for Research in Epidemiology and Statistics, INSERM U1153, INRA, Paris, France; Department of Neonatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Houllier
- Department of Obstetrics and Gynaecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nolwenn Le Saché
- Department of Neonatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Daniele De Luca
- Department of Neonatology, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynaecology, University Medical Centre of Nantes, Centre d'Investigation Clinique CIC Mere enfant, Nantes, France; National Institute of Agricultural Research, UMR 1280, Physiology of Nutritional Adaptations, University of Nantes, IMAD and CRNH-Ouest, Nantes, France
| | - Cyril Flamant
- Department of Neonatology, Nantes University Hospital, Nantes, France
| | - Claire Thuillier
- Department of Obstetrics and Gynaecology, Poissy Hospital Centre, Poissy, France
| | - Pascal Boileau
- Department of Neonatology, Poissy Hospital Centre, Poissy, France
| | - Julie Blanc
- Department of Obstetrics and Gynaecology, Marseille Nord University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Véronique Brevaut
- Department of Neonatology, Marseille Nord University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pierre-Emmanuel Bouet
- Department of Obstetrics and Gynaecology, Angers University Hospital, Angers, France
| | - Géraldine Gascoin
- Department of Neonatology, Angers University Hospital, Angers, France
| | - Gaël Beucher
- Department of Obstetrics and Gynaecology, Caen University Hospital, Caen, France
| | | | - Stéphane Bounan
- Department of Obstetrics and Gynaecology, Saint-Denis Hospital, Saint-Denis, France
| | - Pascal Bolot
- Department of Neonatology, Saint-Denis Hospital, Saint-Denis, France
| | - Christophe Poncelet
- Department of Obstetrics and Gynaecology, Pontoise Hospital, Pontoise, France
| | - Corinne Alberti
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, INSERM U1123, ECEVE, Paris, France
| | - Moreno Ursino
- Clinical Epidemiology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche des Cordeliers, Université Paris Cité, INSERM U1138, Inria, HeKA, Paris, France
| | - Camille Aupiais
- Université Paris Cité, INSERM U1123, ECEVE, Paris, France; Paediatric Emergency Department, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Paris Nord University, Paris, France
| | - Olivier Baud
- Université Paris Cité, INSERM U1141, Paris, France; Division of Neonatology and Paediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland.
| |
Collapse
|
12
|
Stratilov VA, Vetrovoy OV, Tyulkova EI. Prenatal Hypoxia Affects Nicotine Consumption and Withdrawal in Adult Rats via Impairment of the Glutamate System in the Brain. Mol Neurobiol 2022; 59:4550-4561. [PMID: 35581520 DOI: 10.1007/s12035-022-02866-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
The role of damaging factors in the prenatal period as a basis for drug addiction in offspring is of great interest. In this study, we aim at deciphering the effects and possible mechanisms of prenatal severe hypoxia (PSH) on predisposition to nicotine addiction in adult rats. In PSH rats, we found an increasing tendency to nicotine consumption in the two-bottle choice test. After 2 weeks of chronic treatment with nicotine via osmotic minipump (9 mg/kg per day), we assessed the symptoms of withdrawal in the conditioned place aversion test after mecamylamine (an antagonist of nicotinic acetylcholine receptors, nAChR) treatment. We showed that the mecamylamine-precipitated withdrawal aversion was stronger in the PSH group than in the control group. This suggests that PSH acts as a predisposing factor for developing nicotine addiction in adulthood. PSH rats also demonstrated an increased level of phosphorylated DARPP-32 protein (known as the relay for dopamine and glutamate signaling) at 34 threonine (pThr34DARPP-32) in relation to its total amount in the nucleus accumbens of the striatum (NAc). Meanwhile, no changes in both the content of dopamine in the mesolimbic pathway and the first type of dopamine receptors (DAR1) in NAc were found. The increased rate of DARPP-32 phosphorylation in adult PSH rats might result from excessive glutamatergic stimulation of the dopaminergic (DA) neurons of the ventral tegmental area (VTA) caused by activation of presynaptic nAChR by nicotine. This hypothesis is supported by the observed increase in VGluT2-positive terminals to Nurr1-positive neuronal bodies in VTA in PSH animals. Thus, the altered glutamate signaling phenotype might play a significant role in the development of PSH-related nicotine addiction.
Collapse
Affiliation(s)
- Viktor A Stratilov
- Laboratory of Regulation of Brain Neuronal Functions, Pavlov Institute of Physiology, Russian Academy of Sciences, Makarova emb. 6, 199034, Saint-Petersburg, Russia.
| | - Oleg V Vetrovoy
- Laboratory of Regulation of Brain Neuronal Functions, Pavlov Institute of Physiology, Russian Academy of Sciences, Makarova emb. 6, 199034, Saint-Petersburg, Russia.,Department of Biochemistry, Faculty of Biology, Saint-Petersburg State University, Universitetskaya emb. 7-9, 199034, Saint-Petersburg, Russia
| | - Ekaterina I Tyulkova
- Laboratory of Regulation of Brain Neuronal Functions, Pavlov Institute of Physiology, Russian Academy of Sciences, Makarova emb. 6, 199034, Saint-Petersburg, Russia
| |
Collapse
|
13
|
Takahashi T, Takahashi Y, Fee EL, Saito M, Yaegashi N, Usuda H, Bridges JP, Milad MA, Furfaro L, Carter S, Schmidt AF, Newnham JP, Jobe AH, Kemp MW. Continuous but not pulsed low-dose fetal betamethasone exposures extend the durability of antenatal steroid therapy. Am J Physiol Lung Cell Mol Physiol 2022; 322:L784-L793. [PMID: 35380907 DOI: 10.1152/ajplung.00018.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Antenatal steroid (ANS) therapy is standard care for women at imminent risk of preterm labor. Despite extensive and long-standing use, 40-50% of babies exposed antenatally to steroids do not derive benefit; remaining undelivered 7d or more after ANS treatment is associated with a lack of treatment benefit, and increased risk of harms. We used a pregnant sheep model to evaluate the impact of continuous vs. pulsed ANS treatments on fetal lung maturation at an extended, eight-day treatment to delivery interval. Continuous low-dose ANS treatments for more than 72 hours in duration improved fetal lung maturation at eight days after treatment initiation. If fetal ANS exposure was interrupted, the beneficial ANS effect was lost. Truncated treatments, including that simulating the current clinical treatment regimen, did not improve lung function. Variable fetal lung maturation was correlated to the amount of saturated phosphatidylcholine present in the lung fluid. These data demonstrate that: i) the durability of ANS therapy may be enhanced by employing an extended, low-dose treatment regimen with reducing total dose; and ii) interrupting the continuity of fetal exposure by allowing it to fall below a minimal threshold was associated with comparably poor functional maturation of the preterm ovine lung.
Collapse
Affiliation(s)
- Tsukasa Takahashi
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Yuki Takahashi
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Erin L Fee
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Masatoshi Saito
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Nobuo Yaegashi
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Haruo Usuda
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - James P Bridges
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mark A Milad
- Milad Pharmaceutical Consulting LLC, Plymouth, MI, United States
| | - Lucy Furfaro
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Sean Carter
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Augusto F Schmidt
- Department of Neonatology, Pulmonary Biology and Pediatrics, Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH, United States.,Miller School of Medicine, University of Miami, Miami, FL, United States
| | - John P Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Alan Hall Jobe
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Neonatology, Pulmonary Biology and Pediatrics, Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH, United States
| | - Matthew W Kemp
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan.,School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
14
|
Walters A, McKinlay C, Middleton P, Harding JE, Crowther CA. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2022; 4:CD003935. [PMID: 35377461 PMCID: PMC8978608 DOI: 10.1002/14651858.cd003935.pub5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Infants born preterm (before 37 weeks' gestation) are at risk of respiratory distress syndrome (RDS) and need for respiratory support due to lung immaturity. One course of prenatal corticosteroids, administered to women at risk of preterm birth, reduces the risk of respiratory morbidity and improves survival of their infants, but these benefits do not extend beyond seven days. Repeat doses of prenatal corticosteroids have been used for women at ongoing risk of preterm birth more than seven days after their first course of corticosteroids, with improvements in respiratory outcomes, but uncertainty remains about any long-term benefits and harms. This is an update of a review last published in 2015. OBJECTIVES To assess the effectiveness and safety, using the best available evidence, of a repeat dose(s) of prenatal corticosteroids, given to women who remain at risk of preterm birth seven or more days after an initial course of prenatal corticosteroids with the primary aim of reducing fetal and neonatal mortality and morbidity. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials, including cluster-randomised trials, of women who had already received one course of corticosteroids seven or more days previously and were still at risk of preterm birth, randomised to further dose(s) or no repeat doses, with or without placebo. Quasi-randomised trials were excluded. Abstracts were accepted if they met specific criteria. All trials had to meet criteria for trustworthiness, including a search of the Retraction Watch database for retractions or expressions of concern about the trials or their publications. DATA COLLECTION AND ANALYSIS We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed trial quality and scientific integrity. We chose primary outcomes based on clinical importance as measures of effectiveness and safety, including serious outcomes, for the women and their fetuses/infants, infants in early childhood (age two to less than five years), the infant in mid- to late childhood (age five to less than 18 years) and the infant as an adult. We assessed risk of bias at the outcome level using the RoB 2 tool and assessed certainty of evidence using GRADE. MAIN RESULTS We included 11 trials (4895 women and 5975 babies). High-certainty evidence from these trials indicated that treatment of women who remain at risk of preterm birth seven or more days after an initial course of prenatal corticosteroids with repeat dose(s) of corticosteroids, compared with no repeat corticosteroid treatment, reduced the risk of their infants experiencing the primary infant outcome of RDS (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.90; 3540 babies; number needed to treat for an additional beneficial outcome (NNTB) 16, 95% CI 11 to 29) and had little or no effect on chronic lung disease (RR 1.00, 95% CI 0.83 to 1.22; 5661 babies). Moderate-certainty evidence indicated that the composite of serious infant outcomes was probably reduced with repeat dose(s) of corticosteroids (RR 0.88, 95% CI 0.80 to 0.97; 9 trials, 5736 babies; NNTB 39, 95% CI 24 to 158), as was severe lung disease (RR 0.83, 95% CI 0.72 to 0.97; NNTB 45, 95% CI 27 to 256; 4955 babies). Moderate-certainty evidence could not exclude benefit or harm for fetal or neonatal or infant death less than one year of age (RR 0.95, 95% CI 0.73 to 1.24; 5849 babies), severe intraventricular haemorrhage (RR 1.13, 95% CI 0.69 to 1.86; 5066 babies) and necrotising enterocolitis (RR 0.84, 95% CI 0.59 to 1.22; 5736 babies). In women, moderate-certainty evidence found little or no effect on the likelihood of a caesarean birth (RR 1.03, 95% CI 0.98 to 1.09; 4266 mothers). Benefit or harm could not be excluded for maternal death (RR 0.32, 95% 0.01 to 7.81; 437 women) and maternal sepsis (RR 1.13, 95% CI 0.93 to 1.39; 4666 mothers). The evidence was unclear for risk of adverse effects and discontinuation of therapy due to maternal adverse effects. No trials reported breastfeeding status at hospital discharge or risk of admission to the intensive care unit. At early childhood follow-up, moderate- to high-certainty evidence identified little or no effect of exposure to repeat prenatal corticosteroids compared with no repeat corticosteroids for primary outcomes relating to neurodevelopment (neurodevelopmental impairment: RR 0.97, 95% CI 0.85 to 1.10; 3616 children), survival without neurodevelopmental impairment (RR 1.01, 95% CI 0.98 to 1.04; 3845 children) and survival without major neurodevelopmental impairment (RR 1.02, 95% CI 0.98 to 1.05; 1816 children). An increase or decrease in the risk of death since randomisation could not be excluded (RR 1.06, 95% CI 0.81 to 1.40; 5 trials, 4565 babies randomised). At mid-childhood follow-up, moderate-certainty evidence identified little or no effect of exposure to repeat prenatal corticosteroids compared with no repeat corticosteroids on survival free of neurocognitive impairment (RR 1.01, 95% CI 0.95 to 1.08; 963 children) or survival free of major neurocognitive impairment (RR 1.00, 95% CI 0.97 to 1.04; 2682 children). Benefit or harm could not be excluded for death since randomisation (RR 0.93, 95% CI 0.69 to 1.26; 2874 babies randomised) and any neurocognitive impairment (RR 0.96, 95% CI 0.72 to 1.29; 897 children). No trials reported data for follow-up into adolescence or adulthood. Risk of bias across outcomes was generally low although there were some concerns of bias. For childhood follow-up, most outcomes had some concerns of risk of bias due to missing data from loss to follow-up. AUTHORS' CONCLUSIONS The short-term benefits for babies included less respiratory distress and fewer serious health problems in the first few weeks after birth with repeat dose(s) of prenatal corticosteroids for women still at risk of preterm birth seven days or more after an initial course. The current available evidence reassuringly shows no significant harm for the women or child in early and mid-childhood, although no benefit. Further research is needed on the long-term benefits and risks for the baby into adulthood.
Collapse
Affiliation(s)
- Anthony Walters
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jane E Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
15
|
Takahashi T, Fee EL, Takahashi Y, Saito M, Yaegashi N, Usuda H, Furfaro L, Carter S, Schmidt AF, Newnham JP, Jobe AH, Kemp MW. Betamethasone phosphate reduces the efficacy of antenatal steroid therapy and is associated with lower birthweights when administered to pregnant sheep in combination with betamethasone acetate. Am J Obstet Gynecol 2022; 226:564.e1-564.e14. [PMID: 34626553 DOI: 10.1016/j.ajog.2021.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Antenatal corticosteroid therapy is a standard of care for women at imminent risk of preterm labor. However, the optimal (maximum benefit and minimal risk of side effects) antenatal corticosteroid dosing strategy remains unclear. Although conveying overall benefit when given to the right patient at the right time, antenatal corticosteroid treatment efficacy is highly variable and is not risk-free. Building on earlier findings, we hypothesized that when administered in combination with slow-release betamethasone acetate, betamethasone phosphate and the high maternal-fetal betamethasone concentrations it generates are redundant for fetal lung maturation. OBJECTIVE Using an established sheep model of prematurity and postnatal ventilation of the preterm lamb, we aimed to compare the pharmacodynamic effects of low-dosage treatment with betamethasone acetate only against a standard dosage of betamethasone phosphate and betamethasone acetate as recommended by the American College of Obstetricians and Gynecologists for women at risk of imminent preterm delivery between 24 0/7 and 35 6/7 weeks' gestation. STUDY DESIGN Ewes carrying a single fetus at 122±1 days' gestation (term=150 days) were randomized to receive either (1) maternal intramuscular injections of sterile saline (the saline negative control group, n=12), (2) 2 maternal intramuscular injections of 0.25 mg/kg betamethasone phosphate+betamethasone acetate administered at 24-hour dosing intervals (the betamethasone phosphate+betamethasone acetate group, n=12); or (3) 2 maternal intramuscular injections of 0.125 mg/kg betamethasone acetate administered at 24-hour dosing intervals (the betamethasone acetate group, n=11). The fetuses were surgically delivered 48 hours after treatment initiation and ventilated for 30 minutes to determine functional lung maturation. The fetuses were euthanized after ventilation, and the lungs were collected for analysis using quantitative polymerase chain reaction and Western blot assays. Fetal plasma adrenocorticotropic hormone levels were measured in the cord blood samples taken at delivery. RESULTS Preterm lambs were defined as either antenatal corticosteroid treatment responders or nonresponders using an arbitrary cutoff, being a PaCO2 level at 30 minutes of ventilation being more extreme than 2 standard deviations from the mean value of the normally distributed saline control group values. Compared with the animals in the saline control group, the animals in the antenatal corticosteroid treatment groups showed significantly improved lung physiological responses (blood gas and ventilation data) and had a biochemical signature (messenger RNA and surfactant protein assays) consistent with functional maturation. However, the betamethasone acetate group had a significantly higher treatment response rate than the betamethasone phosphate+betamethasone acetate group. These physiological results were strongly correlated to the amount of surfactant protein A. Birthweight was lower in the betamethasone phosphate+betamethasone acetate group and the fetal hypothalamic-pituitary-adrenal axis was suppressed to a greater extent in the betamethasone phosphate+betamethasone acetate group. CONCLUSION Low-dosage antenatal corticosteroid therapy solely employing betamethasone acetate was sufficient for fetal lung maturation. The elevated maternal-fetal betamethasone concentrations associated with the coadministration of betamethasone phosphate did not in addition improve lung maturation but were associated with greater fetal hypothalamic-pituitary-adrenal axis suppression, a lower antenatal corticosteroid treatment response rate, and lower birthweight-outcomes not desirable in a clinical setting. These data warranted a clinical investigation of sustained low-dosage antenatal corticosteroid treatments that avoid high maternal-fetal betamethasone exposures.
Collapse
Affiliation(s)
- Tsukasa Takahashi
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan.
| | - Erin L Fee
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Yuki Takahashi
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masatoshi Saito
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Nobuo Yaegashi
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Haruo Usuda
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Lucy Furfaro
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Sean Carter
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Augusto F Schmidt
- Perinatal Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH; Miller School of Medicine, University of Miami, Miami, FL
| | - John P Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Alan H Jobe
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia; Perinatal Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH
| | - Matthew W Kemp
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan; School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
16
|
Lustig RH, Collier D, Kassotis C, Roepke TA, Ji Kim M, Blanc E, Barouki R, Bansal A, Cave MC, Chatterjee S, Choudhury M, Gilbertson M, Lagadic-Gossmann D, Howard S, Lind L, Tomlinson CR, Vondracek J, Heindel JJ. Obesity I: Overview and molecular and biochemical mechanisms. Biochem Pharmacol 2022; 199:115012. [PMID: 35393120 PMCID: PMC9050949 DOI: 10.1016/j.bcp.2022.115012] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
Abstract
Obesity is a chronic, relapsing condition characterized by excess body fat. Its prevalence has increased globally since the 1970s, and the number of obese and overweight people is now greater than those underweight. Obesity is a multifactorial condition, and as such, many components contribute to its development and pathogenesis. This is the first of three companion reviews that consider obesity. This review focuses on the genetics, viruses, insulin resistance, inflammation, gut microbiome, and circadian rhythms that promote obesity, along with hormones, growth factors, and organs and tissues that control its development. It shows that the regulation of energy balance (intake vs. expenditure) relies on the interplay of a variety of hormones from adipose tissue, gastrointestinal tract, pancreas, liver, and brain. It details how integrating central neurotransmitters and peripheral metabolic signals (e.g., leptin, insulin, ghrelin, peptide YY3-36) is essential for controlling energy homeostasis and feeding behavior. It describes the distinct types of adipocytes and how fat cell development is controlled by hormones and growth factors acting via a variety of receptors, including peroxisome proliferator-activated receptor-gamma, retinoid X, insulin, estrogen, androgen, glucocorticoid, thyroid hormone, liver X, constitutive androstane, pregnane X, farnesoid, and aryl hydrocarbon receptors. Finally, it demonstrates that obesity likely has origins in utero. Understanding these biochemical drivers of adiposity and metabolic dysfunction throughout the life cycle lends plausibility and credence to the "obesogen hypothesis" (i.e., the importance of environmental chemicals that disrupt these receptors to promote adiposity or alter metabolism), elucidated more fully in the two companion reviews.
Collapse
Affiliation(s)
- Robert H Lustig
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, CA 94143, United States
| | - David Collier
- Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States
| | - Christopher Kassotis
- Institute of Environmental Health Sciences and Department of Pharmacology, Wayne State University, Detroit, MI 48202, United States
| | - Troy A Roepke
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 08901, United States
| | - Min Ji Kim
- Department of Biochemistry and Toxicology, University of Paris, INSERM U1224 (T3S), 75006 Paris, France
| | - Etienne Blanc
- Department of Biochemistry and Toxicology, University of Paris, INSERM U1224 (T3S), 75006 Paris, France
| | - Robert Barouki
- Department of Biochemistry and Toxicology, University of Paris, INSERM U1224 (T3S), 75006 Paris, France
| | - Amita Bansal
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Matthew C Cave
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY 40402, United States
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, University of South Carolina, Columbia, SC 29208, United States
| | - Mahua Choudhury
- College of Pharmacy, Texas A&M University, College Station, TX 77843, United States
| | - Michael Gilbertson
- Occupational and Environmental Health Research Group, University of Stirling, Stirling, Scotland, United Kingdom
| | - Dominique Lagadic-Gossmann
- Research Institute for Environmental and Occupational Health, University of Rennes, INSERM, EHESP, Rennes, France
| | - Sarah Howard
- Healthy Environment and Endocrine Disruptor Strategies, Commonweal, Bolinas, CA 92924, United States
| | - Lars Lind
- Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Craig R Tomlinson
- Norris Cotton Cancer Center, Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, United States
| | - Jan Vondracek
- Department of Cytokinetics, Institute of Biophysics of the Czech Academy of Sciences, Brno, Czech Republic
| | - Jerrold J Heindel
- Healthy Environment and Endocrine Disruptor Strategies, Commonweal, Bolinas, CA 92924, United States.
| |
Collapse
|
17
|
Braun T, Filleböck V, Metze B, Bührer C, Plagemann A, Henrich W. Dosage escalation of antenatal steroids in preterm twin pregnancies does not improve long-term outcome. J Perinat Med 2022; 50:25-33. [PMID: 34252994 DOI: 10.1515/jpm-2020-0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To analyze long-term effects of antenatal betamethasone (≤16 mg, =24 mg and >24 mg) in preterm twins on infant and childhood morbidity. METHODS Retrospective cohort study among 198 preterm twins. Three follow up time points, including a total of 84 outcomes, were evaluated: first neonatal examination after birth and in the neonatal period up to 10 days after birth using data from the clinic charts; examination from the 21st to the 24th month of life and examination from the 60th to the 64th months, using data from copies of the children's examination booklets sent back by the parents. Dosage-dependent and sex-specific long-term effects of antenatal betamethasone treatment on neonatal, infant and early childhood development and morbidity up to 5.3 years of age were analyzed. RESULTS Dosage escalation of >24 mg was not associated with improved neonatal, infant or early child hood outcome, independent of twin pair structure. In contrast, higher doses >24 mg were significantly linked to increased rates of congenital infections (OR 5.867, 95% CI 1.895-18.167). Male sex as a factor was obvious for lower rates of apnea-bradycardia-syndrome in neonates, higher rates of no free steps after 15 months in infancy and highest rates of motor clumsiness in early childhood. CONCLUSIONS Betamethasone dosage escalation >24 mg in twins born between 23+5 and 33+6 weeks of gestation did not improve neonatal, infant or early childhood morbidity. In contrast, higher doses >24 mg total dose resulted in significantly higher rates of congenital infections and are not recommended. For males, 24 mg betamethasone appears to be the preferable dose.
Collapse
Affiliation(s)
- Thorsten Braun
- Department of Obstetrics, Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Division of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vivien Filleböck
- Department of Obstetrics, Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Boris Metze
- Clinic of Neonatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Bührer
- Clinic of Neonatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Plagemann
- Division of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
18
|
Berger R, Kyvernitakis I, Maul H. Administration of Antenatal Corticosteroids: Current State of Knowledge. Geburtshilfe Frauenheilkd 2022; 82:287-296. [PMID: 35250378 PMCID: PMC8893986 DOI: 10.1055/a-1555-3444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
The administration of a single course of corticosteroids before week 34 + 0 of gestation in cases with impending preterm birth is now standard procedure in obstetric care and firmly
established in the guidelines of different countries. But despite the apparently convincing data, numerous aspects of this intervention have not yet been properly studied. It is still not
clear which corticosteroid achieves the best results. There are very few studies on what constitutes an appropriate dose, circadian rhythms, the time frame in which corticosteroids are
effective, and the balance between the risks and benefits of repeat administration. As the existing studies have rarely included patients before week 24 + 0 of gestation, we have very little
information on the possible benefits of administering corticosteroids before this timepoint. If corticosteroids are administered antenatally after week 34 + 0 of gestation, the short-term
benefit may be offset by the long-term adverse effect on psychomotor development. This present study summarizes the current state of knowledge regarding these issues.
Collapse
Affiliation(s)
- Richard Berger
- Marienhaus Klinikum St. Elisabeth, Klinik für Gynäkologie und Geburtshilfe, Neuwied, Germany
| | - Ioannis Kyvernitakis
- Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Frauenkliniken, Hamburg, Germany
| | - Holger Maul
- Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Frauenkliniken, Hamburg, Germany
| |
Collapse
|
19
|
Altal OF, Al Sharie AH, Al Zu'bi YO, Rawabdeh SA, Khasawneh W, Dawaymeh T, Tashtoush H, Obeidat R, Halalsheh OM. A Comparative Study of the Respiratory Neonatal Outcomes Utilizing Dexamethasone Sodium Phosphate versus a Mixture of Betamethasone Dipropionate and Betamethasone Sodium Phosphate as an Antenatal Corticosteroid Therapy. Int J Gen Med 2021; 14:9471-9481. [PMID: 34949936 PMCID: PMC8688832 DOI: 10.2147/ijgm.s340559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective The aim of this study is to compare the respiratory neonatal outcomes utilizing antenatal dexamethasone sodium phosphate (DSP) versus a mixture of betamethasone dipropionate and betamethasone sodium phosphate (B-DP/SP) for preterm births. Patients and Methods All neonatal intensive care unit (NICU) admissions for prematurity were retrospectively identified at our center in the period between September 2016 and September 2018. Pregnant women expected to give preterm birth and received steroid injections whether it is DSP or B-DP/SP were included in the study. Maternal and obstetrical data along with the corresponding respiratory neonatal outcomes were extracted and analyzed. The population was categorized according to the gestational age into extremely preterm (less than 28 weeks), very preterm (28 up to 32 weeks) and moderate or late preterm (32 up to 37 weeks) in which the repository outcomes were compared in each sub-group. Results A total of 650 premature neonates were included in the analysis. B-DP/SP illustrated a significant reduction in the occurrence of respiratory distress syndrome (RDS) among moderate or late preterm neonates (P = 0.003) compared to DSP. In contrast, a non-significant difference was observed between B-DP/SP and DSP regarding apnea of prematurity and transient tachypnea of the newborn. The number of neonates developed chronic lung disease has been remarkably reduced when using DSP in extremely (P = 0.038) and very (P = 0.046) preterm neonates when compared to B-DP/SP. Conclusion The dual acting B-DP/SP formulation could possess a significant potential in reducing RDS in moderate or late preterm neonates, while DSP groups exhibit a favorable result in the development of chronic lung disease in extreme and very preterm cohorts. Such findings emphasize the need of further clinical trials, pharmacokinetics, pharmacodynamics and cost effectiveness studies to evaluate the durability of these findings.
Collapse
Affiliation(s)
- Omar F Altal
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Ahmed H Al Sharie
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Yazan O Al Zu'bi
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Saif Aldin Rawabdeh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tamara Dawaymeh
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Haneen Tashtoush
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Rawan Obeidat
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Omar M Halalsheh
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| |
Collapse
|
20
|
Chen Y, Xia X, Fang M, Chen G, Cao J, Qu H, Wang H. Maternally derived low glucocorticoid mediates adrenal developmental programming alteration in offspring induced by dexamethasone. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 797:149084. [PMID: 34303245 DOI: 10.1016/j.scitotenv.2021.149084] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Adverse environments during pregnancy can increase susceptibility to chronic diseases in adult offspring. The occurrence and development of fetal-originated diseases were associated with adrenal developmental programming and homeostasis alteration in offspring. Dexamethasone is widely used for preterm delivery-related pregnancy diseases, but the intrauterine programming alteration and its occurrence mechanism of prenatal dexamethasone exposure (PDE) on adrenal development in offspring have not been clarified. In this study, prenatal dexamethasone therapy could inhibit neonatal development and cause a low exposure of maternally derived glucocorticoid in clinic. Then, we established a rat model of PDE and observed a similar phenomenon. Further, the adrenal steroidogenic function was continuously inhibited in the PDE male offspring rats, accompanied by the decreased H3K27ac level of adrenal insulin-like growth factor 1 (IGF1) and its expression. Moreover, chronic stress in PDE adult offspring rats could reverse the changes of the above indicators through the high level of glucocorticoid. In combination with in vivo, in vitro and a series of interference experiments, we confirmed that the low level of endogenous glucocorticoids inhibited the adrenal IGF1 expression and steroidogenic function through the GRα/miR-370-3p/Sirt3 pathway. In summary, PDE could continuously inhibit the adrenal steroidogenic function in the male offspring, which is associated with the maternally derived low glucocorticoid-mediated the adrenal developmental programming alteration in offspring. This study provides a theoretical and experimental basis for explaining the adrenal development origin of PDE-induced adult chronic diseases.
Collapse
Affiliation(s)
- Yawen Chen
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Xuan Xia
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Man Fang
- Department of Obstetrics and Gynaecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Guanghui Chen
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China
| | - Jiangang Cao
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Hui Qu
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Hui Wang
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China; Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China.
| |
Collapse
|
21
|
Húngaro TGR, Gregnani MF, Alves-Silva T, Herse F, Alenina N, Bader M, Araújo RC. Cortisol Dose-Dependently Impairs Migration and Tube-like Formation in a Trophoblast Cell Line and Modulates Inflammatory and Angiogenic Genes. Biomedicines 2021; 9:biomedicines9080980. [PMID: 34440184 PMCID: PMC8393357 DOI: 10.3390/biomedicines9080980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Several stimuli can change maternal hormone levels during pregnancy. These changes may affect trophoblastic cells and modulate the development of the embryo and the placental tissue itself. Changes in cortisol levels are associated with impaired trophoblast implantation and function, in addition to other pregnancy complications. This study aims to analyze the effects of low and high doses of cortisol on an extravillous trophoblast cell line, and the effects of various exposures to this hormone. SGHPL-4 cells were treated with cortisol at five doses (0–1000 nM) and two exposures (continuous: 24 h/day; and intermittent: 2 h/day). In intermittent treatment, cortisol acted mainly as an anti-inflammatory hormone, repressing gene expression of kinin B1 receptors, interleukin-6, and interleukin-1β. Continuous treatment modulated inflammatory and angiogenic pathways, significantly repressing angiogenic factors and their receptors. Cortisol affected cell migration and tube-like structures formation. In conclusion, both continuous and intermittent exposure to cortisol repressed the expression of inflammatory genes, while only continuous exposure repressed the expression of angiogenic genes, suggesting that a sustained increase in the levels of this hormone is more harmful than a high short-term increase. Cortisol also impaired tube-like structures formation, and kinin receptors may be involved in this response.
Collapse
Affiliation(s)
- Talita Guerreiro Rodrigues Húngaro
- Nephrology Program, Laboratory of Genetics and Exercise Metabolism, Biophysics Department, Federal University of São Paulo (UNIFESP), São Paulo 04039-032, Brazil;
| | - Marcos F. Gregnani
- Molecular Biology Program, Laboratory of Genetics and Exercise Metabolism, Biophysics Department, Federal University of São Paulo (UNIFESP), São Paulo 04039-032, Brazil; (M.F.G.); (T.A.-S.)
| | - Thaís Alves-Silva
- Molecular Biology Program, Laboratory of Genetics and Exercise Metabolism, Biophysics Department, Federal University of São Paulo (UNIFESP), São Paulo 04039-032, Brazil; (M.F.G.); (T.A.-S.)
| | - Florian Herse
- Max-Delbrück Center for Molecular Medicine (MDC), Robert-Rössle-Str. 10, 13125 Berlin, Germany; (F.H.); (N.A.)
- Experimental and Clinical Research Center (ECRC), a Cooperation of Charité—Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine (MDC), Lindenberger Weg 80, 13125 Berlin, Germany
- Berlin Institute of Health, 10178 Berlin, Germany
| | - Natalia Alenina
- Max-Delbrück Center for Molecular Medicine (MDC), Robert-Rössle-Str. 10, 13125 Berlin, Germany; (F.H.); (N.A.)
- Berlin Institute of Health, 10178 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10117 Berlin, Germany
| | - Michael Bader
- Max-Delbrück Center for Molecular Medicine (MDC), Robert-Rössle-Str. 10, 13125 Berlin, Germany; (F.H.); (N.A.)
- Berlin Institute of Health, 10178 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10117 Berlin, Germany
- Max Delbrück Center of Molecular Medicine, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
- Institute for Biology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Correspondence: (M.B.); (R.C.A.)
| | - Ronaldo C. Araújo
- Nephrology Program, Laboratory of Genetics and Exercise Metabolism, Biophysics Department, Federal University of São Paulo (UNIFESP), São Paulo 04039-032, Brazil;
- Molecular Biology Program, Laboratory of Genetics and Exercise Metabolism, Biophysics Department, Federal University of São Paulo (UNIFESP), São Paulo 04039-032, Brazil; (M.F.G.); (T.A.-S.)
- Correspondence: (M.B.); (R.C.A.)
| |
Collapse
|
22
|
Taulaigo AV, Moschetti L, Ganhão S, Gerardi MC, Franceschini F, Tincani A, Andreoli L. Safety considerations when using drugs in pregnant patients with systemic lupus erythematosus. Expert Opin Drug Saf 2021; 20:523-536. [PMID: 33599570 DOI: 10.1080/14740338.2021.1893298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Systemic lupus erythematosus (SLE) mainly affects young females during childbearing age; therefore, reproductive issues are of major interest.Areas covered: Pregnancy planning is crucial to adjust the treatment toward drugs that are safe throughout pregnancy and breastfeeding. The evidence about drug safety is limited to post-marketing surveillance, registries, case series, and case reports, as pregnant patients are excluded from randomized clinical trials. The aim of this review is to report the safety considerations when treating pregnant SLE patients. Regarding maternal side effects of drugs, we focused on metabolic, infectious, and hemorrhagic complications. Fetal safety was analyzed looking at drugs teratogenicity, their possible effects on immune system, and on the long-term neuropsychological development of children.Expert opinion: The management of pregnancy in SLE has changed when knowledge about the safety of drugs has become available. Keeping SLE disease activity under control before, during and after pregnancy is of fundamental importance to ensure the best possible outcomes for mother and child. All these issues must be discussed with the patient and her family during preconception counseling. International efforts in terms of pregnancy registries and reproductive health guidelines help physicians improve their communication with SLE patients.
Collapse
Affiliation(s)
- Anna Viola Taulaigo
- Unidade De Doenças Auto-imunes/Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário De Lisboa Central, Lisboa, Portugal
| | - Liala Moschetti
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara Ganhão
- Rheumatology Department, Centro Hospitalar E Universitário De São João, Porto, Portugal
| | - Maria-Chiara Gerardi
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| |
Collapse
|
23
|
Jing J, Dai Y, Li Y, Zhou P, Li X, Mei J, Zhang C, Sangild PT, Tang Z, Xu S, Su Y, He X, Zhu Y. Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant. BMC Pregnancy Childbirth 2021; 21:50. [PMID: 33435921 PMCID: PMC7801876 DOI: 10.1186/s12884-020-03510-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Background Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants. Methods A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes. Results A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed. Conclusions Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.
Collapse
Affiliation(s)
- Jiajia Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshang 2nd Road, Guangzhou, 510080, China
| | - Yiheng Dai
- Department of Neonatology, Foshan Woman and Children's Hospital, Foshan, China
| | - Yanqi Li
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | - Ping Zhou
- Department of Neonatology, Shenzhen Bao'an Maternal and Child Health Hospital, Shenzhen, China
| | - Xiaodong Li
- Department of Neonatology, Shenzhen Nanshan People's Hospital, Shenzhen, China
| | - Jiaping Mei
- Department of Neonatology, Shenzhen Maternity & Child Health Care Hospital, Shenzhen, China
| | - Chunyi Zhang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Per Trop Sangild
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Zhaoxie Tang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshang 2nd Road, Guangzhou, 510080, China
| | - Suhua Xu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshang 2nd Road, Guangzhou, 510080, China
| | - Yanbin Su
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshang 2nd Road, Guangzhou, 510080, China
| | - Xiaoying He
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshang 2nd Road, Guangzhou, 510080, China
| | - Yanna Zhu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, No. 74 Zhongshang 2nd Road, Guangzhou, 510080, China.
| |
Collapse
|
24
|
Stratilov VA, Tyulkova EI, Vetrovoy OV. Prenatal Stress as a Factor of the
Development of Addictive States. J EVOL BIOCHEM PHYS+ 2020. [DOI: 10.1134/s0022093020060010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
25
|
Mihaylova A, Kasnakova P, Gueorguiev S, Petkova-Gueorguieva E, Peikova L. Cost analysis of neonates after prenatal corticosteroid prophylaxis of Respiratory Distress Syndrome. PHARMACIA 2020. [DOI: 10.3897/pharmacia.67.e50458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Preterm birth is a vital global health-economic problem. Health disorders provoked by it generate a high neonatal mortality rate. Prenatal corticosteroid prevention aims to reduce postnatal complications in premature infants. This survey covered two basic baby groups: work group of 89 premature infants that had been subjected to prenatal corticosteroid prophylaxis and a control group of 78 premature babies without prenatal prevention. The analysis of the pharmacoeconomic aspects of prenatal corticosteroid prevention enabled the comparison of clinical and therapeutic results, treatment costs, therapeutic expenditures, shortterm therapeutic effect, benefits and sequences from premature infants’ therapy. The analysis of clinical data obtained during this survey enabled the conclusion that when analyzing the combined effect of Dexamethasone prophylaxis, gestation week at birth and the age of the mother of premature infants with RDS, respiratory obstuction occurrence was mediated by the earlier gestation week at birth, older mother’s age and, at this background, it was restricted to a certain extent by prenatal corticosteroid administration. Conclusions: Prenatal corticosteroids cause reduction of premature infants’ treatment costs. The implementation of a smaller number of dexamethasone applications leads to smaller expenditures for premature infants’ treatment and care compared to those that have more dexamethasone applications.
Collapse
|
26
|
Peterson AK, M. Toledo-Corral C, Chavez TA, Naya CH, Johnson M, Eckel SP, Lerner D, Grubbs BH, Farzan SF, Dunton GF, Bastain TM, Breton CV. Prenatal Maternal Cortisol Levels and Infant Birth Weight in a Predominately Low-Income Hispanic Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6896. [PMID: 32967301 PMCID: PMC7559007 DOI: 10.3390/ijerph17186896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/09/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
Infant birth weight influences numerous health outcomes throughout the life course including childhood obesity and metabolic morbidities. Maternal experience of stress, both before and during pregnancy, has been hypothesized to influence fetal growth and birth outcomes. However, these associations currently are not fully understood, due to conflicting results in the published literature. Salivary cortisol is often used as a biological biomarker to assess the diurnal pattern of the hypothalamic-pituitary-adrenal axis (HPA-axis) functioning. Cortisol metrics include both the total cortisol concentration secreted during waking hours, reflected by the area under the curve (AUC), and cortisol dynamics, which include the diurnal cortisol slope (DCS) and the cortisol awakening response (CAR). This study examined the association of these cortisol metrics measured during the third trimester of pregnancy and infant birth weight among 240 mother-infant dyads participating in the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort study, which is predominately comprised of Hispanic low-income women. There were no significant associations with the maternal biological stress response and infant birth weight in this study. More research is needed in larger studies to better understand how the biological stress response influences birth weight in populations facing health disparities.
Collapse
Affiliation(s)
- Alicia K. Peterson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| | - Claudia M. Toledo-Corral
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
- Department of Health Sciences, California State University Northridge, Northridge, CA 91330, USA
| | - Thomas A. Chavez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| | - Christine H. Naya
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| | - Mark Johnson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| | - Sandrah P. Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| | | | - Brendan H. Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA;
| | - Shohreh F. Farzan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| | - Genevieve F. Dunton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Theresa M. Bastain
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| | - Carrie V. Breton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (A.K.P.); (C.M.T.-C.); (T.A.C.); (C.H.N.); (M.J.); (S.P.E.); (S.F.F.); (G.F.D.); (T.M.B.)
| |
Collapse
|
27
|
Chen YT, Hu Y, Yang QY, Son JS, Liu XD, de Avila JM, Zhu MJ, Du M. Excessive Glucocorticoids During Pregnancy Impair Fetal Brown Fat Development and Predispose Offspring to Metabolic Dysfunctions. Diabetes 2020; 69:1662-1674. [PMID: 32409491 PMCID: PMC7372078 DOI: 10.2337/db20-0009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/06/2020] [Indexed: 12/16/2022]
Abstract
Maternal stress during pregnancy exposes fetuses to hyperglucocorticoids, which increases the risk of metabolic dysfunctions in offspring. Despite being a key tissue for maintaining metabolic health, the impacts of maternal excessive glucocorticoids (GC) on fetal brown adipose tissue (BAT) development and its long-term thermogenesis and energy expenditure remain unexamined. For testing, pregnant mice were administered dexamethasone (DEX), a synthetic GC, in the last trimester of gestation, when BAT development is the most active. DEX offspring had glucose, insulin resistance, and adiposity and also displayed cold sensitivity following cold exposure. In BAT of DEX offspring, Ppargc1a expression was suppressed, together with reduced mitochondrial density, and the brown progenitor cells sorted from offspring BAT demonstrated attenuated brown adipogenic capacity. Increased DNA methylation in Ppargc1a promoter had a fetal origin; elevated DNA methylation was also detected in neonatal BAT and brown progenitors. Mechanistically, fetal GC exposure increased GC receptor/DNMT3b complex in binding to the Ppargc1a promoter, potentially driving its de novo DNA methylation and transcriptional silencing, which impaired fetal BAT development. In summary, maternal GC exposure during pregnancy increases DNA methylation in the Ppargc1a promoter, which epigenetically impairs BAT thermogenesis and energy expenditure, predisposing offspring to metabolic dysfunctions.
Collapse
Affiliation(s)
- Yan-Ting Chen
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA
| | - Yun Hu
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA
| | - Qi-Yuan Yang
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA
| | - Jun Seok Son
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA
| | - Xiang-Dong Liu
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA
| | - Jeanene M de Avila
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA
| | - Mei-Jun Zhu
- School of Food Sciences, Washington State University, Pullman, WA
| | - Min Du
- Nutrigenomics and Growth Biology Laboratory, Department of Animal Sciences, Washington State University, Pullman, WA
| |
Collapse
|
28
|
Dong J, Shin N, Chen S, Lei J, Burd I, Wang X. Is there a definite relationship between placental mTOR signaling and fetal growth? Biol Reprod 2020; 103:471-486. [PMID: 32401303 DOI: 10.1093/biolre/ioaa070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
Fetal growth restriction and overgrowth are common obstetrical complications that result in adverse perinatal outcomes and long-term health risks later in life, including neurodevelopmental dysfunction and adult metabolic syndrome. The placenta plays a critical role in the nutrition transfer from mother to fetus and even exerts adaptive mechanism when the fetus is under poor developmental conditions. The mammalian/mechanistic target of rapamycin (mTOR) signaling serves as a critical hub of cell growth, survival, and metabolism in response to nutrients, growth factors, energy, and stress signals. Placental mTOR signaling regulates placental function, including oxygen and nutrient transport. Therefore, placental mTOR signaling is hypothesized to have a positive relationship with fetal growth. In this review, we summarize that most studies support the current evidence that there is connection between placental mTOR signaling and abnormal fetal growth; however, but more studies should be performed following a vigorous and unanimous method for assessment to determine placental mTOR activity.
Collapse
Affiliation(s)
- Jie Dong
- Reproductive Medical Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Na Shin
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shuqiang Chen
- Reproductive Medical Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Jun Lei
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaohong Wang
- Reproductive Medical Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| |
Collapse
|
29
|
Diguisto C, Arthuis C, Couderchet J, Morgan AS, Perrotin F, Rivière O, Vendittelli F. Impact of antenatal corticosteroids on head circumference of full-term newborns: A French multicenter cohort study. Acta Obstet Gynecol Scand 2020; 99:1147-1154. [PMID: 32162298 DOI: 10.1111/aogs.13839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Our main objective was to evaluate whether antenatal corticosteroids increase the risk of small head circumference in children born at term. Secondary objectives were to evaluate whether they increase the risk of small birthweight and birth length among those children. MATERIAL AND METHODS A historical cohort included 275 270 live term born children between 2000 and 2013 in 175 French maternity units. The rate of head circumference below the 5th percentile among children born at term and exposed to antenatal corticosteroids was compared with that of two unexposed groups: those children born at term whose mothers had an episode of threatened preterm labor without corticosteroids and those whose mothers had neither threatened preterm labor nor corticosteroids. The association between this treatment and head circumference was evaluated by calculating adjusted risk ratios (aRRs) and their 95% confidence intervals (CIs). The main outcome measure was a head circumference below the 5th percentile at birth, adjusted for sex, and gestational age according to the Pediatric, Obstetrics, and Gynecology Electronic Records Users Association (AUDIPOG) curves. Secondary outcomes were birthweight and birth length below the 5th percentile. RESULTS The rate of head circumference below the 5th percentile was 5.8% (n = 3388) among children exposed to antenatal corticosteroids and 4.3% (n = 7077) and 4.6% (n = 198 462), respectively, for the two unexposed groups. After adjustment, the risk of having a head circumference below the 5th percentile did not differ between the exposed group and the two control groups (aRR 1.28, 95% confidence interval [CI] 0.97-1.69] and aRR 0.91, 95% CI 0.74-1.13). We did not find an association between antenatal corticosteroids and the rate of birthweight below the 5th percentile. Children exposed to antenatal corticosteroids had a higher risk of a birth length below the 5th percentile when compared with those not exposed to threatened preterm labor or corticosteroids. CONCLUSIONS We found no association between antenatal corticosteroids and increased risk of head circumference below the 5th percentile in children born at term.
Collapse
Affiliation(s)
- Caroline Diguisto
- Department of Obstetrics and Gynecology, Regional University Hospital of Tours, Tours, France.,François Rabelais University, Tours, France.,Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, France
| | - Judith Couderchet
- Department of Obstetrics and Gynecology, Regional University Hospital of Tours, Tours, France.,François Rabelais University, Tours, France
| | - Andrei S Morgan
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Elizabeth Garret Anderson Institute for Womens' Health, University College London, London, UK.,SAMU 93 - SMUR Pédiatrique, CHI André Gregoire Hospital, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Regional University Hospital of Tours, Tours, France.,François Rabelais University, Tours, France
| | - Olivier Rivière
- Claude Bernard Lyon 1 University-Laennec, Audipog, Lyon, France
| | - Françoise Vendittelli
- Claude Bernard Lyon 1 University-Laennec, Audipog, Lyon, France.,Clermont Auvergne University, CHU Clermont-Ferrand Hospital, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| |
Collapse
|
30
|
Castelli V, Lavanco G, Brancato A, Plescia F. Targeting the Stress System During Gestation: Is Early Handling a Protective Strategy for the Offspring? Front Behav Neurosci 2020; 14:9. [PMID: 32082129 PMCID: PMC7006220 DOI: 10.3389/fnbeh.2020.00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/15/2020] [Indexed: 12/28/2022] Open
Abstract
The perinatal window is a critical developmental time when abnormal gestational stimuli may alter the development of the stress system that, in turn, influences behavioral and physiological responses in the newborns. Individual differences in stress reactivity are also determined by variations in maternal care, resulting from environmental manipulations. Despite glucocorticoids are the primary programming factor for the offspring's stress response, therapeutic corticosteroids are commonly used during late gestation to prevent preterm negative outcomes, exposing the offspring to potentially aberrant stress reactivity later in life. Thus, in this study, we investigated the consequences of one daily s.c. injection of corticosterone (25 mg/kg), from gestational day (GD) 14-16, and its interaction with offspring early handling, consisting in a brief 15-min maternal separation until weaning, on: (i) maternal behavior; and (ii) behavioral reactivity, emotional state and depressive-like behavior in the adolescent offspring. Corticosterone plasma levels, under non-shock- and shock-induced conditions, were also assessed. Our results show that gestational exposure to corticosterone was associated with diminished maternal care, impaired behavioral reactivity, increased emotional state and depressive-like behavior in the offspring, associated with an aberrant corticosterone response. The early handling procedure, which resulted in increased maternal care, was able to counteract the detrimental effects induced by gestational corticosterone exposure both in the behavioral- and neurochemical parameters examined. These findings highlight the potentially detrimental consequences of targeting the stress system during pregnancy as a vulnerability factor for the occurrence of emotional and affective distress in the adolescent offspring. Maternal extra-care proves to be a protective strategy that confers resiliency and restores homeostasis.
Collapse
Affiliation(s)
- Valentina Castelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Gianluca Lavanco
- INSERM U1215, Neuro Centre Magendie, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy
| | - Anna Brancato
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy
| | - Fulvio Plescia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "Giuseppe D'Alessandro", University of Palermo, Palermo, Italy
| |
Collapse
|
31
|
Abstract
Preterm birth occurs with 10% of deliveries and yet accounts for more than 85% of perinatal morbidity and mortality. Management of preterm labor prior to delivery includes a multipronged pharmacologic approach targeting utilization of reproductive hormones for continuation of pregnancy, advancement of fetal lung maturity, and the decrease of uterine contractility (tocolysis). This article will review and compare guidelines on pharmacologic management of preterm labor as recommended by the American College of Obstetricians and Gynecologists and the European Association of Perinatal Medicine. The classifications of drugs discussed include exogenous progesterone, corticosteroids, and tocolytics (β-adrenergic agonists, magnesium sulfate, calcium channel blockers, prostaglandin inhibitors, nitrates, and oxytocin receptor blockers). For each of these drug classes, the following information will be presented: mechanism of action, maternal/fetal side effects, and nursing implications.
Collapse
|
32
|
Abrantes MA, Valencia AM, Bany-Mohammed F, Aranda JV, Beharry KD. Intergenerational Influence of Antenatal Betamethasone on Growth, Growth Factors, and Neurological Outcomes in Rats. Reprod Sci 2020; 27:418-431. [PMID: 32046399 DOI: 10.1007/s43032-019-00073-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
Antenatal steroids suppress growth in the fetus and newborn. Although weight deficits are regained by weaning, studies show that intrauterine growth restriction with postnatal "catch-up" growth is a risk factor for hypertension, insulin resistance, and ischemic heart disease in adult life, with multigenerational consequences. We tested the hypothesis that fetal exposure to betamethasone suppresses fetal growth in the F1 pups and their untreated F2 offspring. Timed pregnant rats received a single two-dose course of intramuscular betamethasone (0.25 mg/kg/day) on days 17 and 18 of gestation. Matched controls received equivalent volumes sterile normal saline. The first-generation (F1) offspring were studied at term, P21, and P70, or mated at P60 to produce the following subgroups: (1) saline male/saline female (SM/SF), (2) betamethasone (B) male/BFemale (BM/BF), (3) BM/SF, and (4) SM/BF. The unexposed second-generation (F2) offspring were examined at birth and P70. Growth, neurological outcomes, and growth factors were determined. At birth, the F1 pups exposed to B were significantly growth suppressed compared with the controls, with correspondingly lower blood glucose, insulin, IGF-I, corticosterone, and leptin levels and delayed neurological outcomes. Catchup growth occurred at P21, surpassing that of the control group. By P70, growth was comparable, but glucose was higher, insulin was lower, and memory was retarded in the B group, and transmitted to the unexposed F2 offspring of B-exposed rats. Antenatal betamethasone has sustained metabolic and neurological effects that may impact the unexposed offspring. Whether these intergenerational effects reverse in future generations remain to be determined.
Collapse
Affiliation(s)
- Maria A Abrantes
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of California, Irvine Medical Center, Orange, CA, USA.,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA.,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Kaiser Permanente, Irvine, CA, USA
| | - Arwin M Valencia
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of California, Irvine Medical Center, Orange, CA, USA.,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA.,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Saddleback Memorial Medical Center, Laguna Hills, CA, USA
| | - Fayez Bany-Mohammed
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Jacob V Aranda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.,Department of Ophthalmology, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Kay D Beharry
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of California, Irvine Medical Center, Orange, CA, USA. .,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA. .,Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA. .,Department of Ophthalmology, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA. .,Departments of Pediatrics & Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA. .,Department of Pediatrics & Ophthalmology, Neonatal-Perinatal Medicine Clinical & Translational Research Labs, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 49, Brooklyn, NY, 11203, USA.
| |
Collapse
|
33
|
Ellman LM, Murphy SK, Maxwell SD, Calvo EM, Cooper T, Schaefer CA, Bresnahan MA, Susser ES, Brown AS. Maternal cortisol during pregnancy and offspring schizophrenia: Influence of fetal sex and timing of exposure. Schizophr Res 2019; 213:15-22. [PMID: 31345704 PMCID: PMC7074891 DOI: 10.1016/j.schres.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Maternal stress during pregnancy has been repeatedly linked to increased risk for schizophrenia; however, no study has examined maternal cortisol during pregnancy and risk for the disorder. Study aims were to determine whether prenatal cortisol was associated with risk for schizophrenia and risk for an intermediate phenotype-decreased fetal growth-previously linked to prenatal cortisol and schizophrenia. Timing of exposure and fetal sex also were examined given previous findings. METHODS Participants were 64 cases diagnosed with schizophrenia spectrum disorders (SSD) and 117 controls from a prospective birth cohort study. Maternal cortisol was determined from stored sera from each trimester and psychiatric diagnoses were assessed from offspring using semi-structured interviews and medical records review. RESULTS Maternal cortisol during pregnancy was not associated with risk for offspring schizophrenia. There was a significant interaction between 3rd trimester cortisol and case status on fetal growth. Specifically, cases exposed to higher 3rd trimester maternal cortisol had significantly decreased fetal growth compared to controls. In addition, these findings were restricted to male offspring. CONCLUSIONS Our results indicate that higher prenatal cortisol is associated with an intermediate phenotype linked to schizophrenia, fetal growth, but only among male offspring who developed schizophrenia. Findings were consistent with evidence that schizophrenia genes may disrupt placental functioning specifically for male fetuses, as well as findings that males are more vulnerable to maternal cortisol during pregnancy. Finally, results suggest that examining fetal sex and intermediate phenotypes may be important in understanding the mechanisms involved in prenatal contributors to schizophrenia.
Collapse
Affiliation(s)
- Lauren M Ellman
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Shannon K Murphy
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Seth D Maxwell
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Evan M Calvo
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13(th) Street, Philadelphia, PA 19106, United States of America.
| | - Thomas Cooper
- Analytic Psychopharmacology, Nathan S. Kline Institute, 140 Old Orangeburg Road Orangeburg, NY 10962, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Catherine A Schaefer
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Michaeline A Bresnahan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Ezra S Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America.
| | - Alan S Brown
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, United States of America; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, United States of America; Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, United States of America.
| |
Collapse
|
34
|
Ae-Ngibise KA, Wylie BJ, Boamah-Kaali E, Jack DW, Oppong FB, Chillrud SN, Gyaase S, Kaali S, Agyei O, Kinney PL, Mujtaba M, Wright RJ, Asante KP, Lee AG. Prenatal maternal stress and birth outcomes in rural Ghana: sex-specific associations. BMC Pregnancy Childbirth 2019; 19:391. [PMID: 31664941 PMCID: PMC6819589 DOI: 10.1186/s12884-019-2535-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high prenatal maternal stress was associated with reduced birth length (β = − 0.91, p = 0.04; p-value for trend = 0.04). Among girls, moderate and high prenatal maternal stress was associated with reduced birth weight (β = − 0.16, p = 0.02; β = − 0.18, p = 0.04 respectively; p-value for trend = 0.04) and head circumference (β = − 0.66, p = 0.05; β = − 1.02, p = 0.01 respectively; p-value for trend = 0.01). In girls, high prenatal stress increased odds of any adverse birth outcome (OR 2.41, 95% CI 1.01-5.75; p for interaction = 0.04). Sex-specific analyses did not demonstrate significant effects in boys. Conclusions All infants, but especially girls, were vulnerable to effects of prenatal maternal stress on birth outcomes. Understanding risk factors for impaired fetal growth may help develop preventative public health strategies. Trial registration NCT01335490 (prospective registration). Date of Registration: April 14, 2011. Status of Registration: Completed.
Collapse
Affiliation(s)
- Kenneth Ayuurebobi Ae-Ngibise
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Blair J Wylie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen Boamah-Kaali
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Darby W Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Felix Boakye Oppong
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, NY, USA
| | - Stephaney Gyaase
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Seyram Kaali
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Oscar Agyei
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Mohammed Mujtaba
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Rosalind J Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kwaku Poku Asante
- Ghana Health Service, Kintampo Health Research Centre, Brong Ahafo Region, Kintampo, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA.
| |
Collapse
|
35
|
Trus I, Darbellay J, Huang Y, Gilmour M, Safronetz D, Gerdts V, Karniychuk U. Persistent Zika virus infection in porcine conceptuses is associated with elevated in utero cortisol levels. Virulence 2019; 9:1338-1343. [PMID: 30058440 PMCID: PMC7000198 DOI: 10.1080/21505594.2018.1504558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ivan Trus
- a Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan , Saskatoon , Canada
| | - Joseph Darbellay
- a Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan , Saskatoon , Canada
| | - Yanyun Huang
- b Prairie Diagnostic Services , Saskatoon , Canada
| | - Matthew Gilmour
- c Canada National Microbiology Laboratory, Public Health Agency of Canada , Winnipeg , Canada
| | - David Safronetz
- c Canada National Microbiology Laboratory, Public Health Agency of Canada , Winnipeg , Canada
| | - Volker Gerdts
- a Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan , Saskatoon , Canada.,d Department of Veterinary Microbiology , Western College of Veterinary Medicine, University of Saskatchewan , Saskatoon , Canada
| | - Uladzimir Karniychuk
- a Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan , Saskatoon , Canada.,d Department of Veterinary Microbiology , Western College of Veterinary Medicine, University of Saskatchewan , Saskatoon , Canada.,e School of Public Health , University of Saskatchewan , Saskatoon , Canada
| |
Collapse
|
36
|
Michaëlsson H, Andersson M, Svensson J, Karlsson L, Ehn J, Culley G, Engström A, Bergström N, Savvidi P, Kuhn H, Hanse E, Seth H. The novel antidepressant ketamine enhances dentate gyrus proliferation with no effects on synaptic plasticity or hippocampal function in depressive-like rats. Acta Physiol (Oxf) 2019; 225:e13211. [PMID: 30347138 DOI: 10.1111/apha.13211] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/18/2022]
Abstract
AIM Major depressive disorder is a common and debilitating condition with substantial economic impact. Treatment options, although effective, are aimed at relieving the symptoms with limited disease modification. Ketamine, a commonly used anaesthetic, has received substantial attention as it shows rapid antidepressant effects clinically. We studied the effects of ketamine on hippocampal function and dentate gyrus proliferation in rats showing a depressive-like phenotype. METHODS Adolescent and adult animals were pre-natally exposed to the glucocorticoid analog dexamethasone, and we verified a depressive-like phenotype using behavioural tests, such as the sucrose preference. We subsequently studied the effects of ketamine on hippocampal synaptic transmission, plasticity and dentate gyrus proliferation. In addition, we measured hippocampal glutamate receptor expression. We also tested the ketamine metabolite hydroxynorketamine for NMDA-receptor independent effects. RESULTS Surprisingly, our extensive experimental survey revealed limited effects of ketamine or its metabolite on hippocampal function in control as well as depressive-like animals. We found no effects on synaptic efficacy or induction of long-term potentiation in adolescent and adult animals. Also there was no difference when comparing the dorsal and ventral hippocampus. Importantly, however, ketamine 24 hours prior to experimentation significantly increased the dentate gyrus proliferation, as revealed by Ki-67 immunostaining, in the depressive-like phenotype. CONCLUSION We find limited effects of ketamine on hippocampal glutamatergic transmission. Instead, alterations in dentate gyrus proliferation could explain the antidepressant effects of ketamine.
Collapse
Affiliation(s)
- Henrik Michaëlsson
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Mats Andersson
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Johan Svensson
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Lars Karlsson
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Johan Ehn
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Georgia Culley
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Anders Engström
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Nicklas Bergström
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Parthenia Savvidi
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Hans‐Georg Kuhn
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Eric Hanse
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| | - Henrik Seth
- Department of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
| |
Collapse
|
37
|
Schmitz T, Alberti C, Ursino M, Baud O, Aupiais C. Full versus half dose of antenatal betamethasone to prevent severe neonatal respiratory distress syndrome associated with preterm birth: study protocol for a randomised, multicenter, double blind, placebo-controlled, non-inferiority trial (BETADOSE). BMC Pregnancy Childbirth 2019; 19:67. [PMID: 30755164 PMCID: PMC6373166 DOI: 10.1186/s12884-019-2206-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although antenatal betamethasone is recommended worldwide for women at risk of preterm delivery, concerns persist regarding the long-term effects associated with this treatment. Indeed, adverse events, mainly dose-related, have been reported. The current recommended dose of antenatal betamethasone directly derives from sheep experiments performed in the late 60's and has not been challenged in 45 years. Therefore, randomized trials evaluating novel dose regimens are urgently needed. METHODS A randomised, double blind, placebo-controlled, non-inferiority trial will be performed in 37 French level 3 maternity units. Women with a singleton pregnancy at risk of preterm delivery before 32 weeks of gestation having already received a first 11.4 mg injection of betamethasone will be randomised to receive either a second injection of 11.4 mg betamethasone (full dose arm) or placebo (half dose arm) administered intramuscularly 24 h after the first injection. The primary binary outcome will be the occurrence of severe respiratory distress syndrome (RDS), defined as the need for exogenous intra-tracheal surfactant in the first 48 h of life. Considering that 20% of the pregnant women receiving the full dose regimen would have a neonate with severe RDS, 1571 patients in each treatment group are required to show that the half dose regimen is not inferior to the full dose, that is the difference in severe RDS rate do not exceed 4% (corresponding to a Relative Risk of 20%), with a 1-sided 2.5% type-1 error and a 80% power. Interim analyses will be done after every 300 neonates who reach the primary outcome on the basis of intention-to-treat, using a group-sequential non-inferiority design. DISCUSSION If the 50% reduced antenatal betamethasone dose is shown to be non-inferior to the full dose to prevent severe RDS associated with preterm birth, then it should be used consistently in women at risk of preterm delivery and would be of great importance to their children. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT 02897076 (registration date 09/13/2016).
Collapse
Affiliation(s)
- Thomas Schmitz
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France
- Université Paris Diderot, Site Villemin, 10 avenue de Verdun, 75010 Paris, France
- Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, 53 avenue de l’observatoire, 75014 Paris, France
| | - Corinne Alberti
- Université Paris Diderot, Site Villemin, 10 avenue de Verdun, 75010 Paris, France
- Unité d’épidémiologie clinique, CIC-EC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
- Inserm, U1123, ECEVE, 10 avenue de Verdun, 75010 Paris, France
| | - Moreno Ursino
- Inserm, U1138, Equipe 22, Sorbonne Université, Université Paris Descartes, 75006 Paris, France
| | - Olivier Baud
- Service de néonatalogie, Hôpitaux universitaires de Genève, 32 boulevard de la Cluse, 1205 Genève, Switzerland
- Inserm, U1141, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
| | - Camille Aupiais
- Université Paris Diderot, Site Villemin, 10 avenue de Verdun, 75010 Paris, France
- Inserm, U1123, ECEVE, 10 avenue de Verdun, 75010 Paris, France
- Inserm, U1138, Equipe 22, Sorbonne Université, Université Paris Descartes, 75006 Paris, France
- Service d’Accueil des Urgences Pédiatriques, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
| | - for the BETADOSE study group and the GROG (Groupe de Recherche en Gynécologie Obstétrique)
- Service de Gynécologie Obstétrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, 48 boulevard Sérurier, 75019 Paris, France
- Université Paris Diderot, Site Villemin, 10 avenue de Verdun, 75010 Paris, France
- Inserm, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, 53 avenue de l’observatoire, 75014 Paris, France
- Unité d’épidémiologie clinique, CIC-EC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
- Inserm, U1123, ECEVE, 10 avenue de Verdun, 75010 Paris, France
- Inserm, U1138, Equipe 22, Sorbonne Université, Université Paris Descartes, 75006 Paris, France
- Service de néonatalogie, Hôpitaux universitaires de Genève, 32 boulevard de la Cluse, 1205 Genève, Switzerland
- Inserm, U1141, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
- Service d’Accueil des Urgences Pédiatriques, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
| |
Collapse
|
38
|
Schmidt M, Rauh M, Schmid MC, Huebner H, Ruebner M, Wachtveitl R, Cordasic N, Rascher W, Menendez-Castro C, Hartner A, Fahlbusch FB. Influence of Low Protein Diet-Induced Fetal Growth Restriction on the Neuroplacental Corticosterone Axis in the Rat. Front Endocrinol (Lausanne) 2019; 10:124. [PMID: 30915031 PMCID: PMC6421269 DOI: 10.3389/fendo.2019.00124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 02/11/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives: Placental steroid metabolism is linked to the fetal hypothalamus-pituitary-adrenal axis. Intrauterine growth restriction (IUGR) might alter this cross-talk and lead to maternal stress, in turn contributing to the pathogenesis of anxiety-related disorders of the offspring, which might be mediated by fetal overexposure to, or a reduced local enzymatic protection against maternal glucocorticoids. So far, direct evidence of altered levels of circulating/local glucocorticoids is scarce. Liquid chromatography tandem-mass spectrometry (LC-MS/MS) allows quantitative endocrine assessment of blood and tissue. Using a rat model of maternal protein restriction (low protein [LP] vs. normal protein [NP]) to induce IUGR, we analyzed fetal and maternal steroid levels via LC-MS/MS along with the local expression of 11beta-hydroxysteroid-dehydrogenase (Hsd11b). Methods: Pregnant Wistar dams were fed a low protein (8%, LP; IUGR) or an isocaloric normal protein diet (17%, NP; controls). At E18.5, the expression of Hsd11b1 and 2 was determined by RT-PCR in fetal placenta and brain. Steroid profiling of maternal and fetal whole blood, fetal brain, and placenta was performed via LC-MS/MS. Results: In animals with LP-induced reduced body (p < 0.001) and placental weights (p < 0.05) we did not observe any difference in the expressional Hsd11b1/2-ratio in brain or placenta. Moreover, LP diet did not alter corticosterone (Cort) or 11-dehydrocorticosterone (DH-Cort) levels in dams, while fetal whole blood levels of Cort were significantly lower in the LP group (p < 0.001) and concomitantly in LP brain (p = 0.003) and LP placenta (p = 0.002). Maternal and fetal progesterone levels (whole blood and tissue) were not influenced by LP diet. Conclusion: Various rat models of intrauterine stress show profound alterations in placental Hsd11b2 gatekeeper function and fetal overexposure to corticosterone. In contrast, LP diet in our model induced IUGR without altering maternal steroid levels or placental enzymatic glucocorticoid barrier function. In fact, IUGR offspring showed significantly reduced levels of circulating and local corticosterone. Thus, our LP model might not represent a genuine model of intrauterine stress. Hypothetically, the observed changes might reflect a fetal attempt to maintain anabolic conditions in the light of protein restriction to sustain regular brain development. This may contribute to fetal origins of later neurodevelopmental sequelae.
Collapse
Affiliation(s)
- Marius Schmidt
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias C. Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Hanna Huebner
- Department of Gynaecology and Obstetrics/Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynaecology and Obstetrics/Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Wachtveitl
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Nada Cordasic
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Fabian B. Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- *Correspondence: Fabian B. Fahlbusch
| |
Collapse
|
39
|
Top-cited articles in the Journal: a bibliometric analysis. Am J Obstet Gynecol 2019; 220:12-25. [PMID: 30452887 DOI: 10.1016/j.ajog.2018.11.1091] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Journal has had a profound influence in nearly 150 years of publishing. A bibliometric analysis, which uses citation analyses to evaluate the impact of articles, can be used to identify the most impactful papers in the Journal's history. OBJECTIVE The objective was to identify and characterize the top-cited articles published in the Journal since 1920. STUDY DESIGN We used the Web of Science and Scopus databases to identify the most frequently cited articles of the Journal from 1920 through 2018. The top 100 articles from each database were included in our analysis. Articles were evaluated for several characteristics including year of publication, article type, topic, open access, and country of origin. Using the Scopus data, we performed an unadjusted categorical analysis to characterize the articles and a 2 time point analysis to compare articles before and after 1995, the median year of publication from each database list. RESULTS The top 100 articles from each database were included in the analysis. This included 120 total articles: 80 articles listed in both and 20 unique in each database. More than half (52%) were observational studies, 9% were RCTs, and 75% were from US authors. When the post-1995 studies were compared with the articles published before 1995, articles were more frequently cited (median 27 vs 13 citations per year, P < .001), more likely to be randomized (14.0% vs 4.8%, P = .009), and more likely to originate from international authors (33.3% vs 17.5%, P = .045). CONCLUSION Slightly more than half of the top-cited papers in the Journal since 1920 were observational studies and three quarters of all papers were from US authors. Compared with top-cited papers before 1995, the Journal's top-cited papers after 1995 were more likely to be randomized and to originate from international authors.
Collapse
|
40
|
Excess Hydrocortisone Hampers Placental Nutrient Uptake Disrupting Cellular Metabolism. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5106174. [PMID: 30402483 PMCID: PMC6198558 DOI: 10.1155/2018/5106174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/31/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022]
Abstract
Low birth weight increases neonatal morbidity and mortality, and surviving infants have increased risk of metabolic and cardiovascular disturbances later in life, as well as other neurological, psychiatric, and immune complications. A gestational excess of glucocorticoids (GCs) is a well-known cause for fetal growth retardation, but the biological basis for this association remains elusive. Placental growth is closely related to fetal growth. The placenta is the main regulator of nutrient transport to the fetus, resulting from the difference between placental nutrient uptake and the placenta's own metabolism. The aim of this study was to analyze how excess hydrocortisone affects placental glucose and lipid metabolism. Human placenta explants from term physiological pregnancies were cultured for 18 hours under different hydrocortisone concentrations (2.75, 5.5, and 55 mM; 1, 2, and 20 mg/ml). Placental glucose and lipid uptake and the metabolic partitioning of fatty acids were quantified by isotopic techniques, and expression of specific glucose transporter GLUT1 was quantified by western blot. Cell viability was assessed by MTT, immunohistochemistry and caspase activity. We found that excess hydrocortisone impairs glucose uptake and lipoprotein lipase (LPL) activity, coincident with a GC-dose dependent inhibition of fatty acid oxidation and esterification. None of the experimental conditions showed an increased cell death. In conclusion, our results show that GC overexposure exerts a dysfunctional effect on lipid transport and metabolism and glucose uptake in human placental explants. These findings could well be directly related to a reduced placental growth and possibly to a reduced supply of nutrients to the fetus and the consequent fetal growth retardation and metabolic programming.
Collapse
|
41
|
Hooper SB, Te Pas AB, Polglase GR, Wyckoff M. Animal models in neonatal resuscitation research: What can they teach us? Semin Fetal Neonatal Med 2018; 23:300-305. [PMID: 30001819 DOI: 10.1016/j.siny.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Animal models have made and continue to make important contributions to neonatal medicine. For example, studies in fetal sheep have taught us much about the physiology of the fetal-to-neonatal transition. However, whereas animal models allow multiple factors to be investigated in a logical and systematic manner, no animal model is perfect for humans and so we need to understand the fundamental differences in physiology between the species in question and humans. Although most physiological systems are well conserved between species, some small differences exist and so wherever possible the knowledge generated from preclinical studies in animals should be tested in clinical trials. However, with the rise of evidence-based medicine the distinction between scientific knowledge generation and evidence gathering has been confused and the two have been lumped together. This misunderstands the contribution that scientific knowledge can provide. Science should be used to guide the gathering of evidence by informing the design of clinical trials, thereby increasing their likelihood of success. While scientific knowledge is not evidence, in the absence of evidence it is likely to be the best option for guiding clinical practice.
Collapse
Affiliation(s)
- Stuart B Hooper
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Myra Wyckoff
- Department of Pediatrics, Neonatal and Perinatal Medicine, University of Texas, South Western Medical Center, Dallas, TX, USA
| |
Collapse
|
42
|
Braun F, Hardt AK, Ehrlich L, Sloboda DM, Challis JRG, Plagemann A, Henrich W, Braun T. Sex-specific and lasting effects of a single course of antenatal betamethasone treatment on human placental 11β-HSD2. Placenta 2018; 69:9-19. [PMID: 30213491 DOI: 10.1016/j.placenta.2018.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION We have previously shown that even a single course of antenatal betamethasone (BET) as an inductor for lung maturity reduces birth weight and head circumference. Moreover, animal studies link BET administration to alterations of the hypothalamic-pituitary-adrenal-gland-axis (HPA). The unhindered development of the fetal HPA axis is dependent on the function and activity of 11β-hydroxysteroiddehydrogenase type 2 (11β-HSD2), a transplacental cortisol barrier. Therefore, we investigated the effects of BET on this transplacental barrier and fetal growth. METHODS Pregnant women treated with a single course of BET between 23 + 5 to 34 + 0 weeks of gestation were compared to gestational-age-matched controls. Placental size and neonatal anthropometrics were taken. Cortisol and ACTH levels were measured in maternal and umbilical cord blood samples. Placental 11β-hydroxysteroiddehydrogenase type 1 (11β-HSD1) protein levels and 11β-HSD2 protein and activity levels were determined. Parameters were analyzed independent of sex, and in subgroups divided by gender and gestational age. RESULTS In term born females, BET administration was associated with reduced head circumference and decreased 11β-HSD2 protein levels and enzyme activity. Males treated with BET, especially those born prematurely, showed increased 11β-HSD2 protein levels. CONCLUSION A single course of BET alters placental glucocorticoid metabolism in a sex-specific manner. Decreased 11β-HSD2 levels in term born females may lead to an increased placental transfer of maternal cortisol and therefore result in a reduced head circumference and a higher risk for altered stress response in adulthood. Further research is needed to conclude the significance of increased 11β-HSD2 levels in males.
Collapse
Affiliation(s)
- F Braun
- Department of Obstetrics and Division of 'Experimental Obstetrics̔, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A K Hardt
- Department of Obstetrics and Division of 'Experimental Obstetrics̔, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Ehrlich
- Department of Obstetrics and Division of 'Experimental Obstetrics̔, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D M Sloboda
- Department of Biochemistry and Biomedical Sciences, Obstetrics & Gynecology and Pediatrics, Farncombe Family Digestive Health Research Institute, McMaster University, Main Street West, Ontario L8S4L8, Hamilton, 1280, Canada
| | - J R G Challis
- Department of Physiology and Obstetrics and Gynecology, University of Toronto King's College Circle, Ontario M5S 1A8, Toronto, Canada; Faculty of Health Sciences, Simon Fraser University, University Drive, 8888, B.C, V5A 1S6, Burnaby, Canada
| | - A Plagemann
- Department of Obstetrics and Division of 'Experimental Obstetrics̔, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - W Henrich
- Department of Obstetrics and Division of 'Experimental Obstetrics̔, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Braun
- Department of Obstetrics and Division of 'Experimental Obstetrics̔, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
43
|
Jordan BK, Schilling D, McEvoy CT. The window of improved neonatal respiratory compliance after rescue antenatal steroids. J Perinatol 2018; 38:828-833. [PMID: 29795314 PMCID: PMC6070394 DOI: 10.1038/s41372-018-0124-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/09/2018] [Accepted: 04/03/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate whether premature infants delivered ≤7 days after rescue antenatal steroid treatment (ideal treatment) have increased passive respiratory compliance compared to those delivered >7 days after treatment (remote treatment). METHODS Secondary analysis of a randomized trial of rescue antenatal steroids on respiratory compliance. Infants in the treatment group were stratified by the interval between rescue antenatal steroids and delivery. We then compared the respiratory compliance in the ideal vs. remote groups. RESULTS Forty-four women (56 infants) received rescue antenatal steroids. Forty-nine infants had evaluable respiratory compliance measurements, with 27 (GA 30.1 weeks, BW 1362 g) "ideally" treated, and 22 (GA 33.8 weeks, BW 2248 g) "remotely" treated. Respiratory compliance was significantly higher for the ideal compared to the remote group (1.32 vs. 1.06 mL/cm H2O/kg; p = 0.037). CONCLUSION Infants treated with rescue antenatal steroids have a significantly higher respiratory compliance if delivery occurs within 7 days after treatment.
Collapse
Affiliation(s)
- Brian K Jordan
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
| | - Diane Schilling
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Cindy T McEvoy
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
44
|
Miranda A, Sousa N. Maternal hormonal milieu influence on fetal brain development. Brain Behav 2018; 8:e00920. [PMID: 29484271 PMCID: PMC5822586 DOI: 10.1002/brb3.920] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/15/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022] Open
Abstract
An adverse maternal hormonal environment during pregnancy can be associated with abnormal brain growth. Subtle changes in fetal brain development have been observed even for maternal hormone levels within the currently accepted physiologic ranges. In this review, we provide an update of the research data on maternal hormonal impact on fetal neurodevelopment, giving particular emphasis to thyroid hormones and glucocorticoids. Thyroid hormones are required for normal brain development. Despite serum TSH appearing to be the most accurate indicator of thyroid function in pregnancy, maternal serum free T4 levels in the first trimester of pregnancy are the major determinant of postnatal psychomotor development. Even a transient period of maternal hypothyroxinemia at the beginning of neurogenesis can confer a higher risk of expressive language and nonverbal cognitive delays in offspring. Nevertheless, most recent clinical guidelines advocate for targeted high-risk case finding during first trimester of pregnancy despite universal thyroid function screening. Corticosteroids are determinant in suppressing cell proliferation and stimulating terminal differentiation, a fundamental switch for the maturation of fetal organs. Not surprisingly, intrauterine exposure to stress or high levels of glucocorticoids, endogenous or synthetic, has a molecular and structural impact on brain development and appears to impair cognition and increase anxiety and reactivity to stress. Limbic regions, such as hippocampus and amygdala, are particularly sensitive. Repeated doses of prenatal corticosteroids seem to have short-term benefits of less respiratory distress and fewer serious health problems in offspring. Nevertheless, neurodevelopmental growth in later childhood and adulthood needs further clarification. Future studies should address the relevance of monitoring the level of thyroid hormones and corticosteroids during pregnancy in the risk stratification for impaired postnatal neurodevelopment.
Collapse
Affiliation(s)
- Alexandra Miranda
- Life and Health Sciences Research Institute (ICVS)School of MedicineUniversity of MinhoBragaPortugal
- ICVS/3B's ‐ PT Government Associate LaboratoryBraga/GuimarãesPortugal
- Department of Obstetrics and GynecologyHospital de BragaBragaPortugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS)School of MedicineUniversity of MinhoBragaPortugal
- ICVS/3B's ‐ PT Government Associate LaboratoryBraga/GuimarãesPortugal
- Clinic Academic Center ‐ 2CABragaPortugal
| |
Collapse
|
45
|
Antenatal glucocorticoids, magnesium sulfate, and mode of birth in preterm fetal small for gestational age. Am J Obstet Gynecol 2018; 218:S818-S828. [PMID: 29422213 DOI: 10.1016/j.ajog.2017.12.227] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/09/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022]
Abstract
A diagnosis of fetal growth restriction and subsequent preterm birth is associated with increased risks of adverse perinatal and neurodevelopmental outcomes and potentially long-lasting effects to adulthood. Most such cases are associated with placental insufficiency and the fetal response to chronic intrauterine hypoxemia and nutrient deprivation leads to substantial physiological and metabolic adaptations. The management of such pregnancies, especially with respect to perinatal interventions and birth mode, remains an unresolved dilemma. The benefits from standard interventions for threatened preterm birth may not be necessarily translated to pregnancies with small-for-gestational-age fetuses. Clinical trials or retrospective studies on outcomes following administration of antenatal glucocorticoids and magnesium sulfate for neuroprotection when preterm birth is imminent either have yielded conflicting results for small-for-gestational-age fetuses, or did not include this subgroup of patients. Experimental models highlight potential harmful effects of administration of antenatal glucocorticoids and magnesium sulfate in the pregnancies with fetal small for gestational age although clinical data do not substantiate these concerns. In addition, heterogeneity in definitions of fetal small for gestational age, variations in the inclusion criteria, and the glucocorticoid regime contribute to inconsistent results. In this review, we discuss the physiologic adaptions of the small-for-gestational-age fetus to its abnormal in utero environment in relation to antenatal glucocorticoids; the impact of antenatal glucocorticoids and intrapartum magnesium sulfate in pregnancies with fetal small for gestational age; the current literature on birth mode for pregnancies with fetal small for gestational age; and the knowledge gaps in the existing literature.
Collapse
|
46
|
Wong TTC, Tung JSZ, Lau HCQ, Tagore S. Antenatal corticosteroids administration: are we giving them at the right time? Arch Gynecol Obstet 2017; 297:373-379. [DOI: 10.1007/s00404-017-4577-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
|
47
|
Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol 2017; 130:e102-e109. [DOI: 10.1097/aog.0000000000002237] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Ferraro AA, Rohde LA, Polanczyk GV, Argeu A, Miguel EC, Grisi SJFE, Fleitlich-Bilyk B. The specific and combined role of domestic violence and mental health disorders during pregnancy on new-born health. BMC Pregnancy Childbirth 2017; 17:257. [PMID: 28764678 PMCID: PMC5540537 DOI: 10.1186/s12884-017-1438-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/24/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Addressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother's mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery. METHODS We followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive-compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed. RESULTS Domestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06-3.17)/physical violence (IRR = 1.95; 95%CI = 1.11-3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = -0.48; 95%CI = -0.85/-0.10) and sexual violence (beta = -1.58; 95%CI = -2.61/-0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms. CONCLUSION Domestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. It is imperative that actions be taken to prevent violence and improve mental health during pregnancy.
Collapse
Affiliation(s)
- Alexandre Archanjo Ferraro
- Department of Pediatrics, School of Medicine, Universidade de Sao Paulo, Av Dr Eneas Carvalho Aguiar, 647, Sao Paulo, 05403-900, Brazil.
| | - Luis Augusto Rohde
- Department of Psychiatry, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil.,Department of Psychiatry and Legal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Adriana Argeu
- Department of Psychiatry, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Bacy Fleitlich-Bilyk
- Department of Psychiatry, School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
49
|
De Silva DA, Lisonkova S, von Dadelszen P, Synnes AR, Magee LA. Timing of delivery in a high-risk obstetric population: a clinical prediction model. BMC Pregnancy Childbirth 2017; 17:202. [PMID: 28662632 PMCID: PMC5492352 DOI: 10.1186/s12884-017-1390-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/21/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The efficacy of antenatal corticosteroid treatment for women with threatened preterm birth depends on timely administration within 7 days before delivery. We modelled the probability of delivery within 7 days of admission to hospital among women presenting with threatened preterm birth, using routinely collected clinical characteristics. METHODS Data from the Canadian Perinatal Network (CPN) were used, 2005-11, including women admitted to hospital with preterm labour, preterm pre-labour rupture of membranes, short cervix without contractions, or dilated cervix or prolapsed membranes without contractions at preterm gestation. Women with fetal anomaly, intrauterine fetal demise, twin-to-twin transfusion syndrome, and quadruplets were excluded. Logistic regression was undertaken to create a predictive model that was assessed for its calibration capacity, stratification ability, and classification accuracy (ROC curve). RESULTS We included 3012 women admitted at 24-28 weeks gestation, or readmitted at up to 34 weeks gestation, to 16 tertiary-care CPN hospitals. Of these, 1473 (48.9%) delivered within 7 days of admission. Significant predictors of early delivery included maternal age, parity, gestational age at admission, smoking, preterm labour, prolapsed membranes, preterm pre-labour rupture of membranes, and antepartum haemorrhage. The area under the ROC curve was 0.724 (95% CI 0.706-0.742). CONCLUSION We propose a useful tool to improve prediction of delivery within 7 days after admission among women with threatened preterm birth. This information is important for optimal corticosteroid treatment.
Collapse
Affiliation(s)
- Dane A. De Silva
- Department of Obstetrics & Gynaecology, University of British Columbia, C420-4500 Oak Street, Vancouver, BC V6H 3N1 Canada
- School of Population and Public Health, University of British Columbia, 2206 E. Mall, Vancouver, BC V6T 1Z9 Canada
| | - Sarka Lisonkova
- Department of Obstetrics & Gynaecology, University of British Columbia, C420-4500 Oak Street, Vancouver, BC V6H 3N1 Canada
- School of Population and Public Health, University of British Columbia, 2206 E. Mall, Vancouver, BC V6T 1Z9 Canada
| | - Peter von Dadelszen
- St. George’s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
- Molecular & Clinical Sciences Research Institute, St. George’s University of London, Rm J0.27, Jenner Wing, Cranmer Terrace, London, SW17 0RE UK
| | - Anne R. Synnes
- Division of Neonatology, Department of Paediatrics, University of British Columbia, 1R14-4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | | | - Laura A. Magee
- Molecular & Clinical Sciences Research Institute, St. George’s University of London, Rm J0.27, Jenner Wing, Cranmer Terrace, London, SW17 0RE UK
| |
Collapse
|
50
|
Abstract
Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family's decision regarding resuscitation, irrespective of membrane rupture status and regardless of fetal number. Administration of betamethasone may be considered in pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at imminent risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids. A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who have an imminent risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. Continued surveillance of long-term outcomes after in utero corticosteroid exposure should be supported. Quality improvement strategies to optimize appropriate and timely antenatal corticosteroid administration are encouraged.
Collapse
|