Clifton Vicki L, Rennie Natascha, Murphy Vanessa E
Mothers and Babies Research Centre, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2006 Apr;46(2):136-40. doi: 10.1111/j.1479-828X.2006.00543.x.
Asthma is a common disease affecting 12% of Australian women with 55% of women experiencing at least one exacerbation during pregnancy. Exacerbations during pregnancy are associated with low birthweight neonates and stillbirth. One of the main reasons for maternal exacerbations during pregnancy is non-compliance with inhaled glucocorticoid treatment due to the misconception that inhaled glucocorticoids are harmful to the fetus.
We have therefore assessed whether the commonly used inhaled glucocorticoids reduce placental glucocorticoid metabolising capacity, by measuring 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD-2) activity. As these treatments potentially increase the exposure of the fetus to the growth-inhibiting effects of glucocorticoids, we also examined the question of whether inhaled glucocorticoid use was associated with reduced birthweight. Pregnant women using budesonide (n = 18), fluticasone propionate alone (n = 14) and fluticasone propionate in combination with the long-acting beta2 agonist salmeterol (n = 9) were compared to a non-asthmatic control group (n = 20).
The use of inhaled budesonide was associated with significantly increased placental 11beta-HSD-2 activity relative to the control group. Inhaled glucocorticoid use for the treatment of asthma was associated with normal birthweight. In the small number of women using combination therapy (fluticasone and salmeterol), there was reduced birthweight compared to the control group.
Inhaled glucocorticoids alone do not adversely affect fetal growth and placental function.
哮喘是一种常见疾病，影响着12%的澳大利亚女性，其中55%的女性在孕期至少经历一次病情加重。孕期病情加重与低体重新生儿及死产有关。孕期母亲病情加重的主要原因之一是由于误解吸入糖皮质激素对胎儿有害而不遵医嘱使用吸入糖皮质激素治疗。
因此，我们通过测量2型11β-羟基类固醇脱氢酶（11β-HSD-2）活性，评估常用吸入糖皮质激素是否会降低胎盘糖皮质激素代谢能力。由于这些治疗可能会增加胎儿暴露于糖皮质激素的生长抑制作用之下，我们还研究了使用吸入糖皮质激素是否与出生体重降低有关这一问题。将使用布地奈德的孕妇（n = 18）、单独使用丙酸氟替卡松的孕妇（n = 14）以及联合使用丙酸氟替卡松和长效β2受体激动剂沙美特罗的孕妇（n = 9）与非哮喘对照组（n = 20）进行比较。
与对照组相比，使用吸入布地奈德会使胎盘11β-HSD-2活性显著增加。使用吸入糖皮质激素治疗哮喘与正常出生体重相关。在少数使用联合治疗（氟替卡松和沙美特罗）的女性中，与对照组相比出生体重降低。
单独使用吸入糖皮质激素不会对胎儿生长和胎盘功能产生不利影响。
