Bone Metabolism in Fetuses of Pregnant Women Exposed to Single and Multiple Courses of Corticosteroids

Overview

Journal Obstet Gynecol

Specialty Gynecology & Obstetrics

Date 2009 Jun 24

PMID 19546756

Citations 7

Authors

Linda Fonseca

Susan M Ramin

Lisa Mele

Ronald J Wapner

Francee Johnson

Alan M Peaceman

Yoram Sorokin

Donald J Dudley

Catherine Y Spong

Kenneth J Leveno

Steve N Caritis

Menachem Miodovnik

Brian Mercer

John M Thorp

Mary Jo OSullivan

Marshall W Carpenter

Dwight J Rouse

Baha Sibai

Affiliations

Soon will be listed here.

Abstract

Objective: To estimate the effect of single and recurrent doses of antenatal corticosteroids on fetal bone metabolism.

Methods: This was a secondary analysis of a cohort of pregnant women from a previously reported randomized, placebo-controlled, multicenter trial of women at risk for preterm delivery who received weekly courses of betamethasone (active) or placebo after an initial course of corticosteroids. Umbilical cord serum levels of carboxy-terminal carboxy-terminal propeptide of type I procollagen and cross-linked carboxy-terminal telopeptide of type I procollagen were measured to assess the rate of fetal bone formation and resorption, respectively. Analysis was stratified according to number of repeat antenatal study courses of betamethasone or placebo (one to three compared with at least four courses, not including the initial course).

Results: Of the 251 umbilical cord serum samples, the median serum carboxy-terminal telopeptide of type I procollagen levels, but not carboxy-terminal propeptide of type I procollagen levels, was significantly lower with repeat betamethasone exposure (55.0 compared with 57.9 micrograms/L, P=.01). In the fetuses exposed to at least four repeat study courses, there was a significant decrease in median carboxy-terminal telopeptide of type-I procollagen levels between repeat betamethasone exposure and placebo (53.4 compared with 58.6 micrograms/L, respectively, P=.04), but there was no difference between groups in the fetuses exposed to 1-3 repeat study courses (57.4 compared with 56.7 micrograms/L, respectively, P=.29).

Conclusion: Levels of umbilical cord serum markers of bone resorption but not formation are reduced in fetuses exposed to repeat courses of antenatal betamethasone. Up to four courses of antenatal betamethasone do not seem to affect fetal bone metabolism.

Level Of Evidence: II.

Citing Articles

General health and social outcomes 50 years after exposure to antenatal betamethasone: follow-up of a randomised controlled trial.

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Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes.

Walters A, McKinlay C, Middleton P, Harding J, Crowther C Cochrane Database Syst Rev. 2022; 4:CD003935.

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Antenatal endogenous and exogenous glucocorticoids and their impact on immune ontogeny and long-term immunity.

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Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes.

Crowther C, McKinlay C, Middleton P, Harding J Cochrane Database Syst Rev. 2015; (7):CD003935.

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Effects of single course and multicourse betamethasone prior to birth in the prognosis of the preterm neonates: A randomized, double-blind placebo-control clinical trial study.

Atarod Z, Taghipour M, Roohanizadeh H, Fadavi S, Taghavipour M J Res Med Sci. 2014; 19(8):715-9.

PMID: 25422655 PMC: 4235090.

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