Department of Rheumatology, Erasmus MC, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
Department of Paediatrics, Subdivision of Endocrinology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Clin Rheumatol. 2023 Jan;42(1):47-54. doi: 10.1007/s10067-022-06347-0. Epub 2022 Aug 30.
The use of long-term corticosteroids during pregnancy has been growing over the past decades. Corticosteroids can be given when an auto-inflammatory disease like rheumatoid arthritis (RA) is too active. Several studies have shown that long-term corticosteroids use in pregnancy is associated with maternal and fetal adverse outcomes, like preeclampsia, shorter gestational age, lower birth weight, and rapid catch-up growth. These last two outcomes could influence the insulin resistance later in life. Our objective was to investigate whether prednisone use in pregnant women with RA induces insulin resistance in offspring.
One hundred three children were included after their mother had participated in a prospective cohort study on RA and pregnancy. Forty-two children were in utero exposed to prednisone and 61 were non-exposed. To assess insulin resistance, we measured homeostasis model of assessment insulin resistance (HOMA-IR) and serum adiponectin and lipid levels, corrected for body fat distribution.
An average of 6 mg prednisone on a daily use gave no difference in mean HOMA-IR (SD) between the children who were prednisone-exposed in utero (1.10 (0.84)) and those non-exposed (1.09 (0.49)). No difference was found in mean adiponectin level, body fat distribution, or lipid levels such as total cholesterol, fasting triglyceride, or high-density lipoprotein.
Children who are prednisone-exposed in utero (low dose) have no increased risk for insulin resistance at the age of approximately 7 years. These findings are reassuring because the prednisone use during pregnancy is increasing worldwide. Further research has to be performed to evaluate if the insulin resistance remains absent in the future. Key Points • What is already known on this topic-long-term corticosteroids use in pregnancy is associated with fetal adverse outcomes, like lower birth weight and rapid catch-up growth which can influence the insulin resistance later in life. • What this study adds-long-term corticosteroids use in pregnant women with rheumatoid arthritis has no increased risk for insulin resistance in the offspring. • How this study might affect research, practice, or policy-findings are reassuring because prednisone use during pregnancy is increasing worldwide. Further research should evaluate if the insulin resistance remains absent in the future.
在过去几十年中，妊娠期间长期使用皮质类固醇的情况有所增加。当自身炎症性疾病（如类风湿关节炎（RA））过于活跃时，可以使用皮质类固醇。几项研究表明，妊娠期间长期使用皮质类固醇与母婴不良结局有关，如子痫前期、妊娠周数较短、出生体重较低和快速追赶生长。后两种结局可能会影响以后的胰岛素抵抗。我们的目的是研究妊娠期间患有 RA 的女性使用泼尼松是否会导致后代出现胰岛素抵抗。
在母亲参加了一项关于 RA 和妊娠的前瞻性队列研究后，共纳入了 103 名儿童。其中 42 名儿童在宫内暴露于泼尼松，61 名儿童未暴露。为了评估胰岛素抵抗，我们测量了稳态模型评估的胰岛素抵抗（HOMA-IR）和血清脂联素及血脂水平，并校正了体脂分布。
平均每天使用 6mg 泼尼松并未导致宫内暴露于泼尼松的儿童（1.10（0.84））和未暴露的儿童（1.09（0.49））的平均 HOMA-IR（SD）存在差异。脂联素水平、体脂分布或总胆固醇、空腹甘油三酯或高密度脂蛋白等血脂水平也无差异。
在大约 7 岁时，宫内暴露于泼尼松（低剂量）的儿童没有增加发生胰岛素抵抗的风险。这些发现令人安心，因为妊娠期间使用泼尼松的情况正在全球范围内增加。需要进一步研究以评估未来胰岛素抵抗是否仍然不存在。
已知的：妊娠期间长期使用皮质类固醇与胎儿不良结局有关，如出生体重较低和快速追赶生长，这可能会影响以后的胰岛素抵抗。
本研究新增内容：妊娠期间患有类风湿关节炎的女性长期使用皮质类固醇不会增加后代发生胰岛素抵抗的风险。
本研究对研究、实践或政策的影响：这些发现令人安心，因为妊娠期间使用泼尼松的情况正在全球范围内增加。进一步的研究应该评估未来胰岛素抵抗是否仍然不存在。
