Abstract

To assess the long-term effects of tadalafil, a therapeutic agent for fetal growth restriction (FGR), we evaluated the developmental progress of 1.5-year-old infants whose mothers had taken tadalafil during pregnancy. Twenty-four infants were assessed. We evaluated infant body weight, height, and head circumference, and performed the Kyoto Scale of Psychological Development (KSPD) test, a standardized developmental assessment covering Postural–Motor (P–M), Cognitive–Adaptive (C–A), and Language-Social (L–S) functions. The sum score was converted to a developmental quotient (DQ). The mean gestational week of the included cases was 36.1 (29–39) weeks, and the mean birth weight was 1841 (874–2646) g. Twenty-one and 20 out of the 24 cases, respectively, attained body weight and height similar to those of age-matched normal infants (within the 3rd percentile); all cases caught up in head circumference. KSPD was performed for 18 cases at 1.5 years of corrected age. The mean DQ scores were 87 (in total): 82 in P–M, 90 in C–A, and 88 in L–S. The total DQ score in one case (5.6%) was less than 70, and ranged from 70 to 85 in five cases (27.7%), and was more than 85 in 11 cases (61.1%). The growth and development of infants born of tadalafil-treated mothers seem to show good progress at a corrected age of 1.5 years.

Highlights

  • Fetal growth restriction (FGR) is an important perinatal disorder associated with increased perinatal mortality rates, morbidity, and neurological sequelae in infants

  • Based on the results of the STRIDER-UK trial showing negative effects of sildenafil in the treatment of FGR [2] and the recruitment of new candidates for the trial was ceased, the study demonstrated a decrease in the mortality rate of FGR fetuses, neonates, and infants

  • Contrary to the occurrence of neonatal persistent pulmonary hypertension due to sildenafil in the Dutch STRIDER study [3], no adverse events related to tadalafil were seen in mothers and neonates in the TADAFER II study

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Summary

Introduction

Fetal growth restriction (FGR) is an important perinatal disorder associated with increased perinatal mortality rates, morbidity, and neurological sequelae in infants. The Japan Agency for Medical Research and Development (AMED) recommended suspension of TADAFER II based on the results of the STRIDER-UK trial showing negative effects of sildenafil in the treatment of FGR [2] and the recruitment of new candidates for the trial was ceased, the study demonstrated a decrease in the mortality rate of FGR fetuses, neonates, and infants. Limiting the cases registered to less than 31 + 6 weeks gestational age (GA), the GA of the tadalafil treatment group was prolonged when compared to that of the conventional treatment group. Such trials report the short-term effects of tadalafil on FGR fetuses, neonates, and infants; the potential long-term effects of the treatment on FGR infants have not been established

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