Effects of Antenatal Corticosteroids on Fetal Hemodynamics: a Longitudinal Study

Overview

Journal Radiol Bras

Specialty Radiology

Date 2024 Jul 12

PMID 38993967

Authors

Maria Claudia Bayao Carelli

Fernando Maia Peixoto-Filho

Luis Guillermo Coca Velarde

Renato Augusto Moreira de Sa

Viviane Monteiro

Edward Araujo Junior

Affiliations

Soon will be listed here.

Abstract

Objective: To study the effect of antenatal corticosteroid administration on fetal hemodynamics using longitudinal analysis of Doppler waveforms in the umbilical artery (UA) and middle cerebral artery (MCA).

Materials And Methods: This was a retrospective study that included 30 fetuses at risk for preterm birth. Twenty-eight pregnant women were treated with betamethasone for fetal lung maturation. Doppler examinations of the UA and MCA were performed once before and three or eight times after corticosteroid administration. We used a Bayesian hierarchical linear model. Reference ranges were constructed, and associations between variables (gestational age and pre-eclampsia) were tested.

Results: The mean maternal age, gestational age at betamethasone administration, and gestational age at delivery were 32.6 ± 5.89 years, 30.2 ± 2.59 weeks, and 32.9 ± 3.42 weeks, respectively. On UA Doppler, there was a significant decrease in the pulsatility index (PI) after corticosteroid administration, with a mean of 0.1147 (credibility interval: 0.03687-0.191) in three observations and a median of 0.1437 (credibility interval: 0.02509-0.2627) in eight observations. However, there was no significant change in the Doppler MCA PI, regardless of gestational age and the presence or absence of pre-eclampsia.

Conclusion: Although antenatal corticosteroid administration induced a significant decrease in the Doppler UA PI, we observed no change in the cerebral vasculature.

References

Henry A, Shand A, Welsh A . The short term fetal cardiovascular effects of corticosteroids used in obstetrics. Australas J Ultrasound Med. 2017; 16(3):135-141. PMC: 5029999. DOI: 10.1002/j.2205-0140.2013.tb00101.x. View

Derks J, Giussani D, Jenkins S, WENTWORTH R, Visser G, Padbury J . A comparative study of cardiovascular, endocrine and behavioural effects of betamethasone and dexamethasone administration to fetal sheep. J Physiol. 1997; 499 ( Pt 1):217-26. PMC: 1159348. DOI: 10.1113/jphysiol.1997.sp021922. View

Gyamfi C, Mele L, Wapner R, Spong C, Peaceman A, Sorokin Y . The effect of plurality and obesity on betamethasone concentrations in women at risk for preterm delivery. Am J Obstet Gynecol. 2010; 203(3):219.e1-5. PMC: 3214971. DOI: 10.1016/j.ajog.2010.04.047. View

Wijnberger L, Bilardo C, Hecher K, Stigter R, Visser G . Effect of antenatal glucocorticoid therapy on arterial and venous blood flow velocity waveforms in severely growth-restricted fetuses. Ultrasound Obstet Gynecol. 2004; 23(6):584-9. DOI: 10.1002/uog.1052. View

Cohlen B, Stigter R, Derks J, Mulder E, Visser G . Absence of significant hemodynamic changes in the fetus following maternal betamethasone administration. Ultrasound Obstet Gynecol. 1996; 8(4):252-5. DOI: 10.1046/j.1469-0705.1996.08040252.x. View

Lee H, Lyndon A, Blumenfeld Y, Dudley R, Gould J . Antenatal steroid administration for premature neonates in California. Obstet Gynecol. 2011; 117(3):603-609. PMC: 3072287. DOI: 10.1097/AOG.0b013e31820c3c9b. View

Mulder E, de Heus R, Visser G . Antenatal corticosteroid therapy: short-term effects on fetal behaviour and haemodynamics. Semin Fetal Neonatal Med. 2008; 14(3):151-6. DOI: 10.1016/j.siny.2008.10.003. View

Bennet L, Kozuma S, McGarrigle H, Hanson M . Temporal changes in fetal cardiovascular, behavioural, metabolic and endocrine responses to maternally administered dexamethasone in the late gestation fetal sheep. Br J Obstet Gynaecol. 1999; 106(4):331-9. DOI: 10.1111/j.1471-0528.1999.tb08270.x. View

. Antepartum Fetal Surveillance: ACOG Practice Bulletin, Number 229. Obstet Gynecol. 2021; 137(6):e116-e127. DOI: 10.1097/AOG.0000000000004410. View

10.

Kemp M, Saito M, Usuda H, Molloy T, Miura Y, Sato S . Maternofetal pharmacokinetics and fetal lung responses in chronically catheterized sheep receiving constant, low-dose infusions of betamethasone phosphate. Am J Obstet Gynecol. 2016; 215(6):775.e1-775.e12. DOI: 10.1016/j.ajog.2016.08.017. View

11.

Rotmensch S, Liberati M, Celentano C, Efrat Z, Bar-Hava I, Kovo M . The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries. Acta Obstet Gynecol Scand. 1999; 78(9):768-73. View

12.

Thuring A, Malcus P, Marsal K . Effect of maternal betamethasone on fetal and uteroplacental blood flow velocity waveforms. Ultrasound Obstet Gynecol. 2011; 37(6):668-72. DOI: 10.1002/uog.8879. View

13.

Derks J, Mulder E, Visser G . The effects of maternal betamethasone administration on the fetus. Br J Obstet Gynaecol. 1995; 102(1):40-6. DOI: 10.1111/j.1471-0528.1995.tb09024.x. View

14.

Deren O , Karaer C, Onderoglu L, Yigit N, Durukan T, Bahado-Singh R . The effect of steroids on the biophysical profile and Doppler indices of umbilical and middle cerebral arteries in healthy preterm fetuses. Eur J Obstet Gynecol Reprod Biol. 2001; 99(1):72-6. DOI: 10.1016/s0301-2115(01)00367-0. View

15.

Gungor E, Ilhan G, Gultekin H, Zebitay A, Comert S, Verit F . Effect of Betamethasone on Fetal Pulmonary and Umbilical Artery Doppler Velocimetry and Relationship With Respiratory Distress Syndrome Development. J Ultrasound Med. 2017; 36(12):2441-2445. DOI: 10.1002/jum.14280. View

16.

Roberts D, Brown J, Medley N, Dalziel S . Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017; 3:CD004454. PMC: 6464568. DOI: 10.1002/14651858.CD004454.pub3. View

17.

Ekin A, Gezer C, Solmaz U, Taner C, Ozeren M, Dogan A . Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study. J Perinat Med. 2015; 44(2):243-8. DOI: 10.1515/jpm-2015-0194. View

18.

Schwab M, Roedel M, Anwar M, Muller T, Schubert H, Buchwalder L . Effects of betamethasone administration to the fetal sheep in late gestation on fetal cerebral blood flow. J Physiol. 2000; 528(Pt 3):619-32. PMC: 2270156. DOI: 10.1111/j.1469-7793.2000.00619.x. View

19.

Wallace E, Baker L . Effect of antenatal betamethasone administration on placental vascular resistance. Lancet. 1999; 353(9162):1404-7. DOI: 10.1016/S0140-6736(98)08229-4. View

20.

Magee L, Dawes G, Moulden M, Redman C . A randomised controlled comparison of betamethasone with dexamethasone: effects on the antenatal fetal heart rate. Br J Obstet Gynaecol. 1997; 104(11):1233-8. DOI: 10.1111/j.1471-0528.1997.tb10968.x. View