Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Department of Obstetrics and Gynecology, Sinai Health Systems, University of Toronto, Toronto, Ontario, Canada.
Am J Perinatol. 2022 Apr;39(6):592-600. doi: 10.1055/s-0040-1718573. Epub 2020 Oct 14.
A single course of synthetic antenatal corticosteroids is standard care for women considered to be at risk for preterm birth before 34 weeks of gestation. While the intended target is the fetal lung, the fetal brain contains remarkably high levels of glucocorticoid receptors in structures critical in the regulation of behavior and endocrine function. Negative programming signals may occur which can lead to permanent maladaptive changes and predispose the infant/child to an increased risk in physical, mental, and developmental disorders.
Framed around these areas of concerns for physical, mental, and developmental disorders, this narrative review drew on studies (animal and clinical), evaluating the long-term effects of antenatal corticosteroids to present the case that a more targeted approach to the use of antenatal corticosteroids for the betterment of the fetus urgently needed.
Studies raised concerns about the potential negative long-term consequences, especially for the exposed fetus who was born beyond the period of the greatest benefit from antenatal corticosteroids. The long-term consequences are more subtle in nature and usually manifest later in life, often beyond the scope of most clinical trials.
Continued research is needed to identify sufficient safety data, both short term and long term. Caution in the use of antenatal corticosteroids should be exercised while additional work is undertaken to optimize dosing strategies and better identify women at risk of preterm birth prior to administration of antenatal corticosteroids.
· A single-course ACS is a remarkable therapy with substantial benefits.. · There is a potential of long-term neurodevelopmental consequences in the ACS-exposed fetus.. · There is a need to improve dosing strategies and identification of appropriate at risk women..
对于妊娠 34 周前有早产风险的女性，给予单疗程合成产前皮质类固醇是标准治疗方法。虽然预期的靶器官是胎儿肺，但胎儿大脑中的糖皮质激素受体水平在调节行为和内分泌功能的关键结构中非常高。可能会出现负编程信号，导致永久性的适应不良改变，并使婴儿/儿童易患身体、精神和发育障碍的风险增加。
围绕身体、精神和发育障碍的这些关注领域，本叙事性综述借鉴了评估产前皮质类固醇长期影响的研究（动物和临床），提出需要更有针对性地使用产前皮质类固醇来改善胎儿的状况。
研究对潜在的长期负面影响表示担忧，尤其是对于暴露于产前皮质类固醇的胎儿，因为他们出生时已经超过了产前皮质类固醇最大受益的时期。长期后果在性质上更为微妙，通常在生命后期出现，通常超出大多数临床试验的范围。
需要继续研究以确定足够的短期和长期安全性数据。在进行额外的工作以优化剂量策略并更好地识别在给予产前皮质类固醇之前有早产风险的女性时，应谨慎使用产前皮质类固醇。
· 单次 ACS 是一种具有显著益处的卓越疗法。
· ACS 暴露胎儿存在长期神经发育后果的潜在风险。
· 需要改进剂量策略并识别合适的高危女性。
