Department of Obstetrics and Gynaecology and Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
Obstet Gynecol. 2012 May;119(5):917-23. doi: 10.1097/AOG.0b013e31825189dc.
To estimate the effect of multiple courses of antenatal corticosteroids on neonatal size, controlling for gestational age at birth and other confounders, and to determine whether there was a dose-response relationship between number of courses of antenatal corticosteroids and neonatal size.
This is a secondary analysis of the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study, a double-blind randomized controlled trial of single compared with multiple courses of antenatal corticosteroids in women at risk for preterm birth and in which fetuses administered multiple courses of antenatal corticosteroids weighed less, were shorter, and had smaller head circumferences at birth. All women (n=1,858) and children (n=2,304) enrolled in the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study were included in the current analysis. Multiple linear regression analyses were undertaken.
Compared with placebo, neonates in the antenatal corticosteroids group were born earlier (estimated difference and confidence interval [CI]: -0.428 weeks, CI -0.10264 to -0.75336; P=.01). Controlling for gestational age at birth and confounding factors, multiple courses of antenatal corticosteroids were associated with a decrease in birth weight (-33.50 g, CI -66.27120 to -0.72880; P=.045), length (-0.339 cm, CI -0.6212 to -0.05676]; P=.019), and head circumference (-0.296 cm, -0.45672 to -0.13528; P<.001). For each additional course of antenatal corticosteroids, there was a trend toward an incremental decrease in birth weight, length, and head circumference.
Fetuses exposed to multiple courses of antenatal corticosteroids were smaller at birth. The reduction in size was partially attributed to being born at an earlier gestational age but also was attributed to decreased fetal growth. Finally, a dose-response relationship exists between the number of corticosteroid courses and a decrease in fetal growth. The long-term effect of these findings is unknown.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00187382.
II.
控制出生时的胎龄和其他混杂因素，估计多次产前皮质类固醇对新生儿大小的影响，并确定产前皮质类固醇次数与新生儿大小之间是否存在剂量-反应关系。
这是一项针对多次产前皮质类固醇治疗早产研究的二次分析，该研究为单疗程与多疗程产前皮质类固醇治疗有早产风险的妇女的双盲随机对照试验，接受多次产前皮质类固醇治疗的胎儿出生时体重较轻，身长较短，头围较小。所有入组多次产前皮质类固醇治疗早产研究的妇女（n=1858）和儿童（n=2304）均纳入本次分析。进行了多元线性回归分析。
与安慰剂组相比，皮质类固醇组新生儿出生更早（估计差值及置信区间[CI]：-0.428 周，CI-0.10264 至-0.75336；P=.01）。控制出生时的胎龄和混杂因素后，多次产前皮质类固醇与出生体重下降（-33.50 g，CI-66.27120 至-0.72880；P=.045）、身长（-0.339 cm，CI-0.6212 至-0.05676；P=.019）和头围（-0.296 cm，CI-0.45672 至-0.13528；P<.001）下降相关。每增加一次产前皮质类固醇疗程，出生体重、身长和头围均有下降趋势。
接受多次产前皮质类固醇治疗的胎儿出生时较小。这种大小的减少部分归因于更早的胎龄出生，但也归因于胎儿生长减少。最后，皮质类固醇疗程数量与胎儿生长减少之间存在剂量-反应关系。这些发现的长期影响尚不清楚。
ClinicalTrials.gov，www.clinicaltrials.gov，NCT00187382。
II。
