Effect of prenatal betamethasone administration on maternal and fetal corticosteroid-binding globulin concentrations

Jeffray, T; Marinoni, Emanuela; Ramírez, Mildred; Bocking, Alan D.; Challis, John

doi:10.1016/s0002-9378(99)70402-3

Cited by 8 publications

(3 citation statements)

References 27 publications

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“…In animal studies, dose occupies 75% of the singleton fetal corticosteroid receptors, invoking a near maximal induction of receptor-mediated response in fetal target tissues. [11][12][13] By inference, because similar transient reductions in fetal heart rate caused by antenatal corticosteroid administration have been described in both singleton and twin pregnancies, a portion of each betamethasone dose enters the fetal compartments. [14][15][16][17] In clinical practice, the same dose of betamethasone is given irrespective of the pregnancy plurality.…”

Section: Discussionmentioning

confidence: 85%

A Case-Control Comparison of the Effectiveness of Betamethasone to Prevent Neonatal Morbidity and Mortality in Preterm Twin and Singleton Pregnancies

Battista

Winovitch²,

Rumney³

et al. 2008

Amer J Perinatol

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We compared the effectiveness of antenatal betamethasone for the prevention of neonatal morbidity and mortality in preterm twin and singleton gestations. We conducted a case-control study of women with twin versus singleton gestations who received betamethasone for risk of prematurity in a university-affiliated, community-based, tertiary care center between 1997 and 2005. Cases were identified from clinical care and pharmacy databases, then matched for neonatal gender and gestational age (GA) at delivery. Sixty cases and 60 controls of deliveries occurring between 24 and 34 weeks' gestation were identified. The mean GA was 30.4 +/- 2.7 weeks. There were no differences between the groups in maternal demographics (with the exception of maternal age), birth weight, head circumference, Apgar scores, need for mechanical ventilation, days on ventilator, intraventricular hemorrhage grade 3 or 4, necrotizing enterocolitis suspected sepsis, total days in neonatal intensive care unit, or neonatal deaths. No differences in major morbidities or mortality were found in singletons versus twins. Concerns that the added maternal plasma volume in multiple gestations could lessen the neonatal benefits of antenatal betamethasone were not substantiated. This study may be affected by beta-error due to small sample size and sampling bias as a result of a retrospective study.

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Section: Discussionmentioning

confidence: 85%

A Case-Control Comparison of the Effectiveness of Betamethasone to Prevent Neonatal Morbidity and Mortality in Preterm Twin and Singleton Pregnancies

Battista

Winovitch²,

Rumney³

et al. 2008

Amer J Perinatol

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show abstract

“…If glucocorticoid sensitivity of other tissues and cell types increases in a compensatory manner, no adverse consequences will be anticipated. 4) Finally, one study found significantly decreased CBG capacity in cord blood in those samples obtained within 24 h of glucocorticoid treatment and, irrespective of the time between glucocorticoid treatment and assessment, unchanged CBG capacity in cord blood, as well as reduced CBG capacity in amniotic fluid (210). These findings suggest an increased rather than a decreased availability of free plasma cortisol, which obviously cannot explain the phenomenon of reduced hpa activity in infants treated with synthetic glucocorticoids in utero.…”

Section: Alterations In Hpa Axismentioning

confidence: 99%

Effects of Intrauterine Exposure to Synthetic Glucocorticoids on Fetal, Newborn, and Infant Hypothalamic-Pituitary-Adrenal Axis Function in Humans: A Systematic Review

2009

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“…18 pacientes embarazadas con riesgo de parto pretérmino que recibieron cursos repetidos de EP fueron evaluadas posteriormente en sus niveles de cortisol luego de un estímulo; los valores basales fueron menores a los de un grupo control sugiriendo que la administración repetida de betametasona conducía a niveles apenas detectables de cortisol basal e insuficiencia adrenal secundaria 8 . Estos efectos parecen tener un mecanismo diferente a la regulación de los niveles de globulina transportadora de corticosteroides que no fueron afectados a nivel de sangre materna ni fetal (pero sí a nivel de líquido amniótico), luego de la administración de betametasona 9 . Aún con uso de dosis múltiples, no se ha encontrado asociación a supresión adrenal neonatal 10 .…”

Section: Efectos Extrapulmonaresunclassified

Esteroides prenatales: ¿hora de redefinirlos?

Sabogal¹

2001

Rev. Colomb. Obstet. Ginecol.

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La administración de Esteroides Prenatales (EP) con el fin de inducir la maduración pulmonar fetal ha sido una práctica aceptada durante los últimos 20 años, constituyéndose en una de las medidas prenatales más exitosas en términos de reducción de morbilidad y mortalidad perinatal secundaria a Síndrome de Dificultad Respiratoria Neonatal (SDRN). Reciente evidencia, asocia la administración de tales compuestos a diferentes efectos tanto fetales como maternos que suponen riesgos hasta el momento ignorados. Se revisa la literatura publicada en los últimos 6 años en lo referente a aspectos de dosificación, condiciones clínicas específicas (Ruptura prematura de membranas, recién nacido de muy bajo peso), así como las relaciones existentes entre los EP y ciertos desenlaces perinatales (hemorragia subaracnoidea, leucomalacia periventricular). Se concluye que es necesario redefinir sus indicaciones e individualizar su manejo en entornos clínicos específicos, mientras ensayos clínicos controlados que se llevan a cabo en este momento, permiten juicios sólidos.

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Effect of prenatal betamethasone administration on maternal and fetal corticosteroid-binding globulin concentrations

Cited by 8 publications

References 27 publications

A Case-Control Comparison of the Effectiveness of Betamethasone to Prevent Neonatal Morbidity and Mortality in Preterm Twin and Singleton Pregnancies

A Case-Control Comparison of the Effectiveness of Betamethasone to Prevent Neonatal Morbidity and Mortality in Preterm Twin and Singleton Pregnancies

Effects of Intrauterine Exposure to Synthetic Glucocorticoids on Fetal, Newborn, and Infant Hypothalamic-Pituitary-Adrenal Axis Function in Humans: A Systematic Review

Esteroides prenatales: ¿hora de redefinirlos?

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