Roberge Stéphanie, Lacasse Yves, Tapp Sylvie, Tremblay Yves, Kari Anneli, Liu Jing, Fekih Myriam, Qublan Hussein S, Amorim Melania M, Bujold Emmanuel
Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC.
J Obstet Gynaecol Can. 2011 Mar;33(3):216-26. doi: 10.1016/s1701-2163(16)34822-8.
Antenatal glucocorticoid (AGC) therapy has been associated with a decrease in respiratory distress syndrome (RDS). While preterm males remain at greater risk of RDS than females, the role of fetal sex in AGC response is not well known.
To review the available evidence regarding the effect of fetal sex in the prevention of RDS using AGC.
We conducted a systematic review and meta-analysis of RCTs to compare the effect of AGC in male and female infants with regard to the rates of RDS, intra-ventricular hemorrhage (IVH) grades III and IV, and neonatal mortality. Random effects with 95% confidence intervals were assessed in both groups and relative risks were compared using mixed regression.
From 248 potentially eligible articles, we included eight in the analysis for a total of 1109 male and 968 female infants. Both male and female infants had a significant decrease in the risks, but no difference between the sexes was observed in terms of reduction in RDS (RR 0.50; 95% CI 0.33 to 0.77 for males, and RR 0.57; 95% CI 0.43 to 0.75 for females, P = 0.99), reduction in IVH (P = 0.98), and reduction in neonatal mortality (P = 0.43). In a sub-analysis, use of betamethasone was associated with a significant decrease in the rate of RDS in males (RR 0.29; 95% CI 0.15 to 0.57) but dexamethasone was not (RR 0.78; 95% CI 0.57 to 1.07). Conversely, dexamethasone use was significantly helpful in females (RR 0.51; 95% CI 0.32 to 0.81) but betamethasone was not (RR 0.62; 95% CI 0.38 to 1.00).
The effect of AGC for prevention of RDS is similar in females and males. However, futures studies should investigate the type of AGC according to fetal/neonatal sex.
产前糖皮质激素（AGC）治疗与呼吸窘迫综合征（RDS）的减少有关。虽然早产男性患RDS的风险仍高于女性，但胎儿性别在AGC反应中的作用尚不清楚。
综述关于胎儿性别在使用AGC预防RDS中作用的现有证据。
我们对随机对照试验进行了系统评价和荟萃分析，以比较AGC对男婴和女婴在RDS发生率、III级和IV级脑室内出血（IVH）以及新生儿死亡率方面的影响。两组均评估了95%置信区间的随机效应，并使用混合回归比较相对风险。
从248篇潜在合格文章中，我们纳入了8篇进行分析，共1109名男婴和968名女婴。男婴和女婴的风险均显著降低，但在RDS降低方面（男性RR 0.50；95%CI 0.33至0.77，女性RR 0.57；95%CI 0.43至0.75，P = 0.99）、IVH降低方面（P = 0.98）和新生儿死亡率降低方面（P = 0.43）未观察到性别差异。在一项亚分析中，使用倍他米松与男性RDS发生率显著降低相关（RR 0.29；95%CI 0.15至0.57），但地塞米松则不然（RR 0.78；95%CI 0.57至1.07）。相反，使用地塞米松对女性有显著帮助（RR 0.51；95%CI 0.32至0.81），但倍他米松则不然（RR 0.62；95%CI 0.38至1.00）。
AGC预防RDS的效果在女性和男性中相似。然而，未来的研究应根据胎儿/新生儿性别研究AGC的类型。
