Braun Thorsten, Filleböck Vivien, Metze Boris, Bührer Christoph, Plagemann Andreas, Henrich Wolfgang
Clinic of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Division of Experimental Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
J Perinat Med. 2020 Oct 5;49(2):127-137. doi: 10.1515/jpm-2020-0204. Print 2021 Feb 23.
To compare the long-term effects of antenatal betamethasone (ANS, ≤16 mg, =24 mg and >24 mg) in twins on infant and childhood growth.
A retrospective cohort follow up study among 198 twins after ANS including three time points: U1 first neonatal examination after birth and in the neonatal period; U7 examination from the 21st to the 24th month of life and U9 examination from the 60th to the 64th month of life using data from copies of the children's examination booklets. Inclusion criteria are twin pregnancies with preterm labor, cervical shortening, preterm premature rupture of membranes, or vaginal bleeding, and exposure to ANS between 23+5 and 33+6 weeks. Outcome measures are dosage-dependent and sex-specific effects of ANS on growth (body weight, body length, head circumference, body mass index and ponderal index) up to 5.3 years.
Overall, 99 live-born twin pairs were included. Negative effects of ANS on fetal growth persisted beyond birth, altered infant and childhood growth, independent of possible confounding factors. Overall weight percentile significantly decreased between infancy and early childhood by 18.8%. Birth weight percentiles significantly changed in a dose dependent and sex specific manner, most obviously in female-female and mixed pairs. The ponderal index significantly decreased up to 42.9%, BMI index increased by up to 33.8%.
ANS results in long-term alterations in infant and childhood growth. Changes between infancy and early childhood in ponderal mass index and BMI, independent of dose or twin pair structure, might indicate an ANS associated increased risk for later life disease.
First-time report on long-term ANS administration growth effects in twin pregnancies, showing persisting alterations beyond birth in infant and childhood growth up to 5.3 years as potential indicator of later life disease risk.
比较产前倍他米松（剂量≤16mg、=24mg和>24mg）对双胎婴儿及儿童期生长发育的长期影响。
对198例接受倍他米松治疗后的双胎进行回顾性队列随访研究，包括三个时间点：U1为出生后及新生儿期的首次新生儿检查；U7为出生后第21至24个月的检查；U9为出生后第60至64个月的检查，使用儿童检查手册副本中的数据。纳入标准为双胎妊娠合并早产、宫颈缩短、胎膜早破或阴道出血，且在孕23⁺⁵至33⁺⁶周期间接受倍他米松治疗。观察指标为倍他米松对5.3岁前生长发育（体重、身长、头围、体重指数和 ponderal指数）的剂量依赖性和性别特异性影响。
总体而言，纳入了99对活产双胎。倍他米松对胎儿生长的负面影响在出生后持续存在，改变了婴儿及儿童期生长发育，且不受可能的混杂因素影响。婴儿期至幼儿期总体体重百分位数显著下降18.8%。出生体重百分位数呈剂量依赖性和性别特异性变化，在女性-女性和混合双胎对中最为明显。ponderal指数显著下降高达42.9%，体重指数增加高达33.8%。
倍他米松导致婴儿及儿童期生长发育的长期改变。婴儿期至幼儿期ponderal质量指数和体重指数的变化，与剂量或双胎对结构无关，可能表明倍他米松与晚年疾病风险增加有关。
首次报道产前倍他米松给药对双胎妊娠生长发育的长期影响，显示出生后至5.3岁的婴儿及儿童期生长发育持续改变，作为晚年疾病风险的潜在指标。
