McKenna D S, Wittber G M, Nagaraja H N, Samuels P
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Am J Obstet Gynecol. 2000 Sep;183(3):669-73. doi: 10.1067/mob.2000.106755.
The purpose of this study was to determine whether repeated doses of maternal corticosteroids suppress the maternal hypothalamic-pituitary-adrenal axis.
The low-dose corticotropin stimulation test (1.0 microg intravenously) was administered a median of 3 days after the last betamethasone dose to 18 pregnant women who had received at least 2 weekly courses of antenatal betamethasone and to 6 control subjects matched for gestational age who had not received antenatal corticosteroids.
The mean basal cortisol level was significantly depressed among women who had received betamethasone with respect to control subjects (1.9 +/- 1.5 vs 26.5 +/- 6.2 microg/dL; P <.001). The maternal cortisol level after corticotropin stimulation was significantly lower in all women who had received betamethasone (P <. 001). The mean time to attainment of peak cortisol level was significantly longer among women who had received betamethasone than among control subjects (37 +/- 6.8 vs 27.4 +/- 1.6 minutes; P <.001).
Repeated courses of betamethasone lead to barely detectable maternal basal cortisol levels and secondary adrenal insufficiency.
本研究旨在确定重复给予母体皮质类固醇是否会抑制母体下丘脑 - 垂体 - 肾上腺轴。
在最后一剂倍他米松给药后中位3天，对18名接受了至少2个每周疗程产前倍他米松的孕妇以及6名匹配孕周但未接受产前皮质类固醇的对照受试者进行低剂量促肾上腺皮质激素刺激试验（静脉注射1.0微克）。
接受倍他米松的女性的平均基础皮质醇水平相对于对照受试者显著降低（1.9±1.5 vs 26.5±6.2微克/分升；P<.001）。所有接受倍他米松的女性在促肾上腺皮质激素刺激后的母体皮质醇水平均显著降低（P<.001）。接受倍他米松的女性达到皮质醇峰值水平的平均时间显著长于对照受试者（37±6.8 vs 27.4±1.6分钟；P<.001）。
重复疗程的倍他米松导致母体基础皮质醇水平几乎检测不到以及继发性肾上腺功能不全。
