Long-term childhood outcomes for babies born at term who were exposed to antenatal corticosteroids

Osteen, Samantha J.; Yang, Ziyi; McKinzie, Alexandra; Teal, Evgenia; Tepper, Robert S.; Rhoads, Eli; Quinney, Sara K.; Haneline, Laura S.; Haas, David M.

doi:10.1016/j.ajog.2022.07.026

Cited by 11 publications

(25 citation statements)

References 27 publications

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“…Synthetic corticosteroids (betamethasone and dexamethasone) are routinely used in obstetrical practice in the management of women at risk of early preterm birth and for some other indications, such as asthma, autoimmune diseases, and congenital adrenal hyperplasia. 1,6,7,10,[14][15][16][17][18][19][20] Exposure to excess corticosteroids before birth is hypothesized to be a key mechanism underlying the fetal origins of adult disease. 4,5,18,19,[21][22][23][24] Recent epidemiologic evidence from human and animal studies suggests that there may be adverse long-term consequences (Table 2) of prenatal administration of corticosteroids.…”

Section: E Xog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

“…15,30 Current ACS practice is to administer a single 2-day course of either betamethasone or dexamethasone to women in preterm labor between 24 and 34 weeks of pregnancy. 10,[13][14][15][16][17][18][19][20] Recent trials demonstrate modest benefits from a single corticosteroid course for late preterm (34-37 weeks of pregnancy), term elective cesarean deliveries, and periviable deliveries. However, many women, perhaps exceeding 50%, with threatened preterm deliveries receive prenatal corticosteroids but do not deliver until after 34 weeks of pregnancy or at term.…”

Section: E Xog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

“…These effects of corticosteroids suggest caution for the expanded use of prenatal corticosteroids beyond at-risk pregnancies at 24-34 weeks. 20,25,26 Adverse medical events in human newborns have also raised concerns about the safety of multiple corticosteroid courses (weekly, repeated or, periodic courses; different from rescue courses). 10,[13][14][15][16][17]30,31 Several studies have established the efficacy of multiple courses, but there are still questions about their safety.…”

Section: E Xog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

“…The HPA axis is a major neuroendocrine pathway that modulates the prenatal stress response. 8,20 The fetal adrenal gland makes unique contributions to both the regulation of fetal development and the timing of parturition and some earlier studies have shown that the fetal HPA axis is highly sensitive to excess levels of corticosteroids that could alter the regulation of HPA function. 6,8,[34][35][36] The ability of the early environment to modify HPA function in adulthood was described more than 60 years ago.…”

Section: Endog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

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Early life corticosteroid overexposure: Epigenetic and fetal origins of adult diseases

Briceño‐Pérez,

Briceño‐Sanabria,

Briceño‐Sanabria

et al. 2023

Intl J Gynecology & Obste

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The relationship between events occurring during intrauterine development and later‐life predisposition to long‐term disease, has been described. The fetus responds to excess intrauterine exposure to high levels of corticosteroids, modifying their physiological development and stopping their growth. Fetal exposure to elevated levels of either endogenous (alterations in fetal hypothalamic‐pituitary‐adrenal axis) or synthetic corticosteroids, is one model of early‐life adversity; to developing adult disease. At the molecular level, there are transcriptional changes in metabolic and growth pathways. Epigenetic mechanisms participate in transgenerational inheritance, not genomic. Exposures that change 11β‐hydroxysteroid dehydrogenase type 2 enzyme methylation status in the placenta can result in transcriptional repression of the gene, causing the fetus to be exposed to higher levels of cortisol. More precise diagnosis and management of antenatal corticosteroids for preterm birth, would potentially decrease the risk of long‐term adverse outcomes. More studies are needed to understand the potential roles of factors to alter fetal corticosteroid exposure. Long‐term infant follow‐up is required to determine whether methylation changes in placenta may represent useful biomarkers of later disease risk. This review, summarize recent advances in the programming of fetal effects of corticosteroid exposure, the role of corticosteroids in epigenetic gene regulation of placental 11β‐hydroxysteroid dehydrogenase type 2 enzyme expression and transgenerational effects.

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Section: E Xog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

Section: E Xog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

Section: E Xog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

Section: Endog Enous Corti Cos Teroids and Fe Tal Ori G In S Of Adult...mentioning

confidence: 99%

See 2 more Smart Citations

Early life corticosteroid overexposure: Epigenetic and fetal origins of adult diseases

Briceño‐Pérez,

Briceño‐Sanabria,

Briceño‐Sanabria

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

“…[18] Moreover, according to a recent cohort study, ACS-exposed infants had no difference in attention deficit disorder (p=0.54) or developmental delay (p=0.10). [19] The latest Cochrane review found that ACS given prior to anticipated preterm delivery reduced the risk of developmental delay by about 50%. [2]…”

Section: Long-term Effects Of Acs In the Offspringmentioning

confidence: 99%

Unresolved issues on the antenatal use of corticosteroids for fetal lung maturation

Tsakiridis¹,

Dagklis²,

Şen³

2022

Perinat J

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Antenatal corticosteroids (ACS) for fetal lung maturation is celebrating the 50th anniversary. The most recent Cochrane review concluded that there is robust evidence that a single course of ACS reduces the risk of perinatal death and respiratory distress syndrome. Some aspects of ACS remain unresolved, including variations in the steroids regimen, effectiveness in certain groups, long-term effects, optimal timing of ACS administration in elective cases. it is well established that a single course of betamethasone or dexamethasone is beneficial in cases of anticipated preterm birth and delivery eventually occurs between two and seven days from administration. The main focus for future research should be on limiting the unnecessary exposure in low-risk pregnancies and investigating the effect in specific groups, periviable and late preterm fetuses.

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Updates on prenatal diagnosis and treatment of congenital adrenal hyperplasia

van’t Westeinde,

Nordenström,

Lajic

2024

Reference Module in Biomedical Sciences

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Long-term childhood outcomes for babies born at term who were exposed to antenatal corticosteroids

Cited by 11 publications

References 27 publications

Early life corticosteroid overexposure: Epigenetic and fetal origins of adult diseases

Early life corticosteroid overexposure: Epigenetic and fetal origins of adult diseases

Unresolved issues on the antenatal use of corticosteroids for fetal lung maturation

Updates on prenatal diagnosis and treatment of congenital adrenal hyperplasia

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