Liggins Institute and.
Department of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, Australia.
Pediatrics. 2018 Jul;142(1). doi: 10.1542/peds.2018-0522. Epub 2018 Jun 12.
Repeat dose(s) of antenatal betamethasone are recommended for women at <32 weeks with ongoing risk of preterm birth. However, there is concern that use of repeat dose(s) in fetal growth restriction (FGR) may increase the risk of later cardiometabolic disease.
We undertook secondary analysis of data from the Australasian Collaborative Trial of Repeat Doses of Corticosteroids Midchildhood Outcome Study to determine if FGR influences the effect of repeat betamethasone on growth and cardiometabolic function. At 6 to 8 years, children underwent anthropometry, dual energy x-ray absorptiometry, intravenous glucose tolerance testing, ambulatory blood pressure monitoring, and spirometry. FGR was defined as severe FGR at entry, cesarean delivery for FGR, or customized birth weight below the third centile.
Of 266 children assessed, FGR occurred in 43 of 127 (34%) exposed to repeat betamethasone and 44 of 139 (32%) exposed to placebo. There was an interaction between FGR and repeat betamethasone treatment for the effect on height ( score mean difference [95% confidence interval]; FGR: 0.59 [0.01 to 1.17]; non-FGR: -0.29 [-0.69 to 0.10]; = .01). However, FGR did not influence the effect of repeat betamethasone on cardiometabolic function, which was similar in treatment groups, both in FGR and non-FGR subgroups.
Repeat antenatal betamethasone treatment had no adverse effects on cardiometabolic function, even in the presence of FGR. It may have a positive effect on height in FGR. Clinicians should use repeat doses of antenatal corticosteroids when indicated before preterm birth, regardless of FGR, in view of the associated neonatal benefits.
对于存在早产风险的 <32 周孕妇，建议重复使用产前倍他米松。然而，人们担心在胎儿生长受限（FGR）中使用重复剂量可能会增加以后患心血管代谢疾病的风险。
我们对来自澳大利亚皮质类固醇重复剂量中儿童期结局研究的二次分析数据进行了研究，以确定 FGR 是否影响重复倍他米松对生长和心血管代谢功能的影响。在 6 至 8 岁时，儿童接受了人体测量学、双能 X 射线吸收法、静脉葡萄糖耐量试验、动态血压监测和肺功能测定。FGR 的定义为进入时严重 FGR、因 FGR 而行剖宫产或定制的出生体重低于第 3 百分位数。
在 266 名接受评估的儿童中，43 名（34%）接受重复倍他米松治疗的 FGR 儿童和 44 名（32%）接受安慰剂治疗的 FGR 儿童发生了 FGR。FGR 与重复倍他米松治疗对身高的影响之间存在交互作用（得分均值差[95%置信区间]；FGR：0.59[0.01 至 1.17]；非 FGR：-0.29[-0.69 至 0.10]； =.01）。然而，FGR 并未影响重复倍他米松对心血管代谢功能的影响，在 FGR 和非 FGR 亚组中，治疗组之间的影响相似。
即使存在 FGR，重复产前倍他米松治疗也不会对心血管代谢功能产生不良影响。它可能对 FGR 中的身高有积极影响。鉴于与新生儿相关的益处，在考虑早产的情况下，临床医生应在需要时使用重复剂量的产前皮质类固醇，而不管 FGR 情况如何。
