Transient Hypertrophic Cardiomyopathy in the Newborn Following Multiple Doses of Antenatal Corticosteroids

Abstract

Postnatal exposure to steroids has been associated with hypertrophic cardiomyopathy (HCM) in the newborn. Such an effect has not been described in infants born to mothers who received antenatal steroids. We report three newborns whose mothers were treated with betamethasone prenatally in different doses, duration of time, and who developed various degrees of HCM diagnosed by echocardiography. There was no maternal evidence of diabetes except for one infant whose mother had a normal fasting and post-prandial blood glucose prior to steroid therapy, but an abnormal one hour postprandial glucose after 8 weeks of betamethasone therapy, with a normal HbA1 C level. There was no family history of HCM, no history of maternal intake of other relevant medications, and no hypertension in all three newborns. Follow-up echocardiography revealed complete resolution of the HCM changes in all infants. We suggest that repeated antenatal maternal steroid intake may cause changes of HCM in the newborn. These changes appear to be dose- and duration-related and are mostly reversible. Further prospective controlled studies to evaluate these observations and to investigate potential mechanisms are warranted.

Cortisol stimulates proliferation and apoptosis in the late gestation fetal heart: differential effects of mineralocorticoid and glucocorticoid receptors

“…26). Several studies have suggested that exogenous glucocorticoids also impact fetal heart development, producing cardiac enlargement (10,23,36,62). Cardiac enlargement is also observed with maternal Cushing's disease (19), and with highdose steroid treatment in infants with congenital adrenal hyperplasia (3,52).…”

Repeat Prenatal Corticosteroid Doses Do Not Alter Neonatal Blood Pressure or Myocardial Thickness: Randomized, Controlled Trial

“…10 An earlier case series described significant septal IVS and posterior wall LVPW hypertrophy in 3 neonates after multiple courses of prenatal corticosteroid treatment. 21 All abnormal findings resolved spontaneously within 6 months. One of those 3 infants was born to a mother with poorly controlled gestational diabetes mellitus, however, and another was one of triplets, which makes it difficult to attribute the findings to corticosteroid treatment alone.…”

Cushing's syndrome in pregnancy and neonatal hypertrophic obstructive cardiomyopathy

“…An imbalance between protective mechanisms and matemai steroid levels may allow excessive transplacental passage of steroids. Hypertophic cardiomyopathy has been re-ACTA P/EDIATR 93 (2004) ported in premature infants given repeated antenatal courses of steroids (6) or postnatal dexamethasone to prevent or treat hronchopulmonary dysplasia (7,8). Dexamethasone is a synthetic glucocorticoid that readily crosses the placenta.…”