Liggins Institute, The University of Auckland, Auckland, New Zealand;
Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand;
Pediatrics. 2015 Feb;135(2):e405-15. doi: 10.1542/peds.2014-2408. Epub 2015 Jan 19.
Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity but could have adverse long-term effects on cardiometabolic health in offspring. We assessed whether exposure to repeat antenatal betamethasone increased risk factors for later cardiometabolic disease in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids.
Women were randomized to betamethasone or placebo treatment, ≥ 7 days after an initial course of glucocorticoids, repeated each week that they remained at risk for preterm birth at <32 weeks' gestation. In this follow-up study, children were assessed at 6 to 8 years' corrected age for body composition, insulin sensitivity, ambulatory blood pressure, and renal function.
Of 320 eligible childhood survivors, 258 were studied (81%; 123 repeat betamethasone group; 135 placebo [single course] group). Children exposed to repeat antenatal betamethasone and those exposed to placebo had similar total fat mass (geometric mean ratio 0.98, 95% confidence interval [CI] 0.78 to 1.23), minimal model insulin sensitivity (geometric mean ratio 0.89, 95% CI 0.74 to 1.08), 24-hour ambulatory blood pressure (mean difference systolic 0 mm Hg, 95% CI -2 to 2; diastolic 0 mm Hg, 95% CI -1 to 1), and estimated glomerular filtration rate (mean difference 1.2 mL/min/1.73 m(2), 95% CI -3.2 to 5.6).
Exposure to repeat doses of antenatal betamethasone compared with a single course of glucocorticoids does not increase risk factors for cardiometabolic disease at early school age.
对有早产风险的女性重复给予糖皮质激素治疗可降低新生儿发病率，但可能对接受过澳大拉西亚重复剂量皮质类固醇试验的母亲所生子女的心脏代谢健康产生不良的长期影响。我们评估了母亲接受重复产前倍他米松治疗的儿童，其发生心脏代谢疾病的危险因素是否增加。
女性随机分为倍他米松或安慰剂治疗组，在首次糖皮质激素疗程后≥7 天，当她们在<32 孕周时仍有早产风险时，每周重复治疗。在这项随访研究中，儿童在 6 至 8 岁的校正年龄时评估身体成分、胰岛素敏感性、动态血压和肾功能。
在 320 名符合条件的儿童幸存者中，有 258 名（81%）进行了研究，其中 123 名儿童接受重复产前倍他米松治疗，135 名儿童接受安慰剂（单次疗程）治疗。接受重复产前倍他米松治疗的儿童与接受安慰剂治疗的儿童的总脂肪量相似（几何均数比 0.98，95%置信区间 [CI] 0.78 至 1.23），最小模型胰岛素敏感性（几何均数比 0.89，95% CI 0.74 至 1.08），24 小时动态血压（收缩压平均差值 0mmHg，95%CI -2 至 2；舒张压平均差值 0mmHg，95%CI -1 至 1）和估算肾小球滤过率（平均差值 1.2mL/min/1.73m2，95%CI -3.2 至 5.6）。
与单次糖皮质激素疗程相比，接受重复产前倍他米松治疗不会增加儿童早期发生心脏代谢疾病的危险因素。
