Maternal Glucocorticoid in Unplanned Premature Labor. Controlled Study on the Effects of Betamethasone Phosphate on the Phospholipids of the Gastric Aspirate and on the Adrenal Cortical Function of the Newborn Infant

Abstract

SummaryThe effects of betamethasone on surfactant composition and neonatal adrenal function were compared with placebo in a doubleblid study, which included 74 patients at risk for premature delivery. The overall incidence of respiratory distress syndrome was low, and no difference was observed between the betamethasone and placebo groups. The phospholipid pattern (lecithin/sphingomyellin ratio, acetone precipitated lecithin, pbosphatidylinositol/sphingomyelin ratio, and phosphatidylglycerol/sphingomyelin ratio) from gastric aspirates of newborn infants was similru in the betamethasone and placebo groups, suggesting a similarity in lung surfactant. The responsiveness of the adrenal cortex of the newborn infants, evaluated by a 2-hr adrenocorticotropic hormone test at the age of 24 hr, did not differ between infants whose mothers had received either betamethasone or placebo. The low incidence of respiratory distress syndrome in the betamethasone and placebo groups was ascribed in part to a high incidence of prolonged rupture of fetal membranes. Our results do not exclude the possibility that antenatal maternal administration of betamethasone could prevent respiratory distress syndrome in other defined high-risk infants. SpeculationMaternal betamethasone administration does not enhance the acceleration of the fetal lung maturation in "fetal stress" due to rupture of fetal membranes, even if the phospholipids of the lung effluent are somewhat immature. Betamethasone phosphate only transiently suppresses fetal adrenal function. Due to the potential long-term side effects, the use of glucocorticoids should be limited to cases in which the risk to develop respiratory distress syndrome is high and spontaneous acceleration of lung maturation is not expected.Liggins and Howie (13) showed in 1972 that betamethasone administered to the mother prevented respiratory distress syndrome (RDS) in premature infants born before the end of the 32nd pregnancy wk. Block et al. ) injected 500 mg hydrocortisone or placebo IV every 12 hr for 48 hr to mothers at risk for premature delivery. They observed a significant reduction of RDS in patients treated with hydrocortisone (at least two injections) when gestation was less than 32 wk.Potential side effects of glucocorticoid treatment in the perinatal period have been reported in experimental animals and humans [see review by Taeusch (22)). There is suggestive evidence that large doses of glucocorticoids given in the perinatal period to rodents decrease the rate of mitosis and myelinization of the brain, with subsequently impaired motor performance (10, 19). There is also suggestive evidence that mothers with preeclampsia treated with betamethasone may have increased fetal deaths compared with controls (13). It has been shown in the rabbit that glucocorticoids may compromise placental function (25). Whether the dose of glucocorticoids given antenatally for the prevention of RDS has any effect on the development of the human infant is unknown. As long as this information is lacking, it is...

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