Does antenatal corticosteroid therapy affect birth weight and head circumference?

Thorp, James A.; Jones, Philip G.; Knox, Eric; Clark, Reese H.

doi:10.1016/s0029-7844(01)01656-8

Cited by 61 publications

(46 citation statements)

References 23 publications

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“…If these mothers remain undelivered after a week of therapy with steroids, some practitioners use repeated courses in the belief that effect of previous dose has worn off even though there is no scientific basis to support this practice [6,[27][28][29]. Long-term follow up studies of infants born after use of a single course of antenatal steroids have not shown any deleterious effects on survivors [4,5,30,31] but there is substantial body of evidence from animal [32][33][34] and human studies that repeated courses of steroids offer no advantage and may even be harmful for the mother as well as the newborn [10,35,36].…”

Section: Discussionmentioning

confidence: 99%

“…Later obstetricians all over the world started using multiple courses of steroids when delivery did not occur after the first course of steroids [6][7][8]. Multiple courses of corticosteroids did not improve outcome but have been associated with higher incidence of chorioamnionitis, severe IVH, intra-uterine growth restriction and impaired postnatal stress regulation [9,10]. Based on epidemiologic data, prenatal corticosteroid use has been implicated in long-term programming of the foetus leading to increased risk of cardiovascular, metabolic and neuroendocrine disorders in adult life [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

Baisden

Sonne

Joshi³

et al. 2007

Placenta

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Antenatal steroids like dexamethasone (DEX) are used to augment foetal lung maturity and there is a major concern that they impair foetal growth. If delivery is delayed after using antenatal DEX, placental function and hence foetal growth may be compromised even further. To investigate the effects of DEX on placental function, we treated 9 pregnant C57/BL6 mice with DEX and 9 pregnant mice were injected with saline to serve as controls. Placental gene expression was studied using microarrays in 3 pairs and other 6 pairs were used to confirm microarray results by semi-quantitative RT-PCR, real-time PCR, in situ hybridization, western blot analysis and Oligo ApopTaq assay. DEXtreated placentas were hydropic, friable, pale, and weighed less (80.0±15.1 mg compared to 85.6.8 ±7.6 mg, p=0.05) (n=62 placentas). Foetal weight was significantly reduced after DEX use (940±32 mg compared to 1162±79 mg, p=0.001) (n=62 foetuses). There was > 99% similarity within and between the three gene chip data sets. DEX led to down-regulation of 1212 genes and up-regulation of 1382 genes. RT-PCR studies showed that DEX caused a decrease in expression of genes involved in cell division such as cyclins A2, B1, D2, cdk 2, cdk 4 and M-phase protein kinase along with growth-promoting genes such as EGF-R, BMP4 and IGFBP3. Oligo ApopTaq assay and western blot studies showed that DEX-treatment increased apoptosis of trophoblast cells. DEX-treatment led to up-regulation of aquaporin 5 and tryptophan hydroxylase genes as confirmed by real-time PCR, and in situ hybridization studies. Thus antenatal DEX treatment led to a reduction in placental and foetal weight, and this effect was associated with a decreased expression of several growth-promoting genes and increased apoptosis of trophoblast cells.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

Baisden

Sonne

Joshi³

et al. 2007

Placenta

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“…Using a de-identified data set from which several other observations have been published, 10,11 we assembled a retrospective cohort of neonates for this study. Clinical data on these neonates were recorded during their hospitalization in the NICU.…”

Section: Methodsmentioning

confidence: 99%

“…From the Pediatrix Medical Group data warehouse, 10,11 we identified infants born between 23 and 30 weeks gestation from January 1, 1997 to December 31, 2004. In the data warehouse, infants are included if they were discharged from a unit; this includes discharged to home, transferred to another institution or death.…”

Section: Methodsmentioning

confidence: 99%

Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

2007

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Objective: To describe the current use of treatments to prevent or treat patent ductus arteriosus (PDA) in preterm infants, examine the association between different treatment strategies and neonatal outcomes and review the variation in these practices between centers.Study design: Cohort study of infants born between 23 and 30 weeks gestation managed by the Pediatrix Medical Group from 1997 to 2004. We collected data on demographics, indomethacin and ligation, and outcomes of the following five groups: prophylactic indomethacin treatment: infants treated with indomethacin on day of life (DOL) 0 or 1; indicated indomethacin treatment: infants treated with indomethacin after DOL 1; PDA without treatment: infants with a PDA without report of treatment; ligation only: infants with a PDA ligation without use of indomethacin and no PDA: infants without a PDA and without treatment.Results: There were 6189 (18%) patients who received prophylactic indomethacin, 5690 (16%) patients received indicated treatment, 3886 (11%) patients had a PDA without treatment, 702 (2%) patients received ligation only and 18 136 (52%) patients had no PDA. In multivariate analysis, mortality among survivors to 2 days of age was lower (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.5 to 0.7, P<0.01) and chronic lung disease, isolated intestinal perforation and severe retinopathy of prematurity (stages 3 and 4) were higher (OR 1.5, 95% CI 1.3 to 1.6, P<0.01; OR 1.5, 95% CI 1.1 to 2.0, P<0.01 and 1.4, 95% CI 1.2 to 1.6, P<0.01, respectively) in the indicated treatment group compared with the PDA without treatment group. The proportion of infants receiving prophylactic indomethacin among all infants and infants receiving indicated treatment among neonates with a report of a PDA varied by site from 0 to 59% (median 9.5%) and 0 to 100% (median 62%), respectively.Conclusions: Indomethacin use for intraventricular hemorrhage prevention and/or treatment of a PDA is common, but the selection of infants for treatment, and the decision of when and how to treat vary widely between centers. Our findings suggest the need for randomized, placebo-controlled trials of the effect of treatment of the PDA in preterm infants.

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“…We previously reported that glucocorticoid levels in lactating mothers from a hotspot region were higher than those from non-exposed regions, with a strong correlation between glucocorticoids (cortisol and cortisone) and dioxin levels in maternal breast milk (Kido et al 2014). Several reports have shown that fetal growth is retarded by excess glucocorticoids or pharmacological doses of dexamethasone (Goedhart et al 2010, Hauser et al 2007, Koppe et al 1977, Thorp et al 2002). Furthermore, a recent study in rats demonstrated that fetuses that were overexposed to high levels of maternal glucocorticoids had intrauterine growth retardation (Kou et al 2014).…”

Section: Discussionmentioning

confidence: 97%

Low birth weight of Vietnamese infants is related to their mother’s dioxin and glucocorticoid levels

Tung

Kido

Honma

et al. 2016

Environ Sci Pollut Res

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We aimed to determine the relationship between dioxin congeners in maternal breast milk and maternal glucocorticoid levels with newborn birth weight after nearly 45 years of use of herbicides in the Vietnam War. The study subjects comprised 58 mother-infant pairs in a region with high dioxin levels in the soil (hotspot) and 62 pairs from a control region. Dioxin levels in maternal breast milk were measured by HRGC-HRMS. Salivary glucocorticoid levels were determined by LC-MS/MS. Dioxin congener levels in mothers from the hotspot were found to be 2-5-fold higher than those in mothers from the control region. Birth weight was inversely correlated with 2,3,7,8-TeCDD and 2,3,4,7,8-PeCDF congener levels. The rate of newborns whose birth weight was less than 2500 g was 3-fold higher in the hotspot (12%) than in the control region (4%). Salivary glucocorticoid levels in mothers with low birth weight infants were significantly higher than those in the normal birth weight group. Low birth weight of Vietnamese newborns in a hotspot for dioxin levels is related to some dioxin congener levels and high glucocorticoid levels in mothers. This finding in mother-infant pairs suggests that excess maternal glucocorticoid levels are related to dioxin burden and they result in low birth weight.

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Does antenatal corticosteroid therapy affect birth weight and head circumference?

Cited by 61 publications

References 23 publications

Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

Antenatal Dexamethasone Treatment Leads to Changes in Gene Expression in a Murine Late Placenta

Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes

Low birth weight of Vietnamese infants is related to their mother’s dioxin and glucocorticoid levels

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