Effects Of Maternal Betamethasone Administration Research Articles

Effect of maternal betamethasone administration on feto-placental vascular resistance in the mouse†.

Antenatal corticosteroids are often administered to women at risk of preterm birth to accelerate fetal lung development; however, there is evidence that this treatment may adversely affect placental function in some fetuses. Our group has recently demonstrated that wave reflections in the umbilical artery (UA), measured using high-frequency ultrasound, are sensitive to placental vascular abnormalities. In the present study, we used this approach to investigate the effect of maternal administration of betamethasone, a clinically relevant corticosteroid, on the feto-placental vasculature of the mouse. Fetuses were assessed at embryonic day (E)15.5 and E17.5 in C57BL6/J mice. At both gestational ages, the UA diameter, UA blood flow, and the wave reflection coefficient were significantly elevated in the betamethasone-treated mice compared to vehicle-treated controls. These observations support the interpretation that placental vascular resistance dropped with betamethasone treatment to an extent that could not be explained by vasodilation of the UA alone. Consistent with clinical studies, the effect of betamethasone on UA end-diastolic velocity was heterogeneous. Our results suggest that UA wave reflections are more sensitive to acute changes in placental vascular resistance compared with the UA pulsatility index, and this technique may have clinical application to identify a favorable placental vascular response to fetal therapies such as antenatal corticosteroids, where the fetal heart rate is likely to vary.

Short-Term (0–48 h) Effects of Maternal Betamethasone Administration on Fetal Heart Rate and Its Variability

The short-term (0-48 h) effects of maternal betamethasone administration on computerized fetal heart rate (FHR) parameters were studied in 36 pregnancies at increased risk for preterm delivery. FHR was recorded for 90 min immediately before the start of betamethasone treatment and again at 6-h intervals during the next 48 h. Multiple linear regression models were used to assess the possible effects on FHR parameters of gestational age, time of day, clinical indication for treatment, and use of tocolytic drugs. Within 12 h after the start of treatment, significant increases occurred in FHR accelerations, and short- and long-term FHR variability (36%, 28%, and 22%, respectively), whereas basal FHR showed a 5% decrease. FHR variability was decreased by 10% at 42-48 h. The observed changes were more pronounced in older (29-33 wk of gestation) compared with younger fetuses (25-28 wk of gestation). Decelerations occurred only in 4 out of 11 compromised fetuses during betamethasone therapy. We conclude that there are significant changes in FHR parameters during the first 48 h after betamethasone administration. These changes are transient in normal fetuses. However, the compromised fetus may be adversely affected by betamethasone.

Visual interpretation of the effect of maternal betamethasone administration on the fetal heart rate pattern

This study was performed to interpret visually the effect of maternal betamethasone administration on the fetal heart patterns in women at risk for preterm delivery. These effects had previously only been described using computer analysis. It was a retrospective study of 54 women who had received two doses of betamethasone 12 hours apart and had fetal heart tracings before, and on the first and second days after steroid administration. The primary outcome measure was change in short-term variability and secondary outcome measures were change in long-term variability, baseline fetal heart rate, accelerations and decelerations. Inter-observer variation of fetal heart rate variability was also measured. Betamethasone caused a significant reduction in short-term variability 1 and 2 days after administration. There was no effect on baseline fetal heart rate or on variable decelerations. A transient decrease in fetal heart rate accelerations was observed on the first day after steroid administration but not on the second day. Inter-observer variability was good between the two observers (GJH and BVI). In most clinical settings, surveillance of fetal wellbeing is achieved most commonly by visual inspection of the fetal heart tracings and not by computer analysis. Clinicians should be aware of the effects of betamethasone on these tracings when considering interventions and/or other tests of fetal wellbeing.

Effects of maternal betamethasone administration on fetal and maternal blood pressure and heart rate in the baboon at 0.7 of gestation

Objective: We sought to determine the effects of the intramuscular maternal administration of betamethasone to the pregnant baboon at 0.7 of gestation on fetal blood pressure and heart rate. Study design: We treated pregnant baboons at 0.7 of gestation with intramuscular betamethasone (n = 4), at a weight-adjusted dose equivalent to the daily dose administered to women in preterm labor or with saline solution (n = 5). Four injections were given at 12-hour intervals. Fetal and maternal blood pressure and heart rate were recorded continuously. Within-group differences and between-group differences were analyzed with repeated measures analysis of variance. Results: Fetal blood pressure increased significantly after betamethasone treatment. Fetal heart rate, maternal blood pressure, and heart rate did not change. Conclusion: Exposure of the developing primate fetus to exogenous glucocorticoid at 0.7 of gestation elevates fetal blood pressure. These findings confirm and extend the observations in the fetal sheep. Further studies are needed to evaluate the mechanisms that are involved and possible long-term consequences of these cardiovascular effects of antenatal glucocorticoid exposure in the fetal primate. (Am J Obstet Gynecol 2002;186:812-7.)

P98Effects of maternal betamethasone administration on fetal Doppler flow velocity waveforms

BackgroundTo investigate the effect of maternal betamethasone administration on fetal arterial, venous and cardiac Doppler flow velocity waveforms.Method Patients: 13 women with singleton pregnancies considered at risk of preterm labour received an intravenous dosis of 2 × 8 mg betamethasone. Study design: Prospective study. Main outcome measures: Doppler studies were performed from the umbilical artery, middle cerebral artery, both uterine arteries, from the ductus venosus, inferior vena cava, right hepatic vein, form the av‐valves, right and left ventricular outflow tract and the ductus arteriosus before and after (30 min, 24, 48 and 72 h) betamethasone administration. Peak systolic velocities and maximum end‐diastolic velocities were recorded. Calculation of the resistance index (RI) for the arterial system, the peak velocity index for veins (PVIV) for the venous system and the E/A ratio for the av‐valves.ResultsNo significant variation was noted in the Doppler measurements before and after betamethasone administration. A slight and reversible increase of the peak systolic velocity of the ductus arteriosus and the right ventricular outflow tract was observed at 30 min after betamethasone administration.ConclusionBetamethasone administration does not cause a significant change of the arterial, venous and intracardiac Doppler flow velocity waveforms in healthy fetuses.

Effect of maternal betamethasone administration at midgestation on baboon fetal adrenal gland development and adrenocorticotropin receptor messenger ribonucleic acid expression.

Although fetal pituitary ACTH is important to fetal adrenal growth and steroidogenesis in the second half of primate pregnancy, its role in adrenal development and function has not been established in vivo in the first half of gestation. In the present study, therefore, baboons were treated at midgestation with betamethasone to determine the effect of fetal pituitary ACTH on fetal adrenal growth, development, and ACTH receptor and P-450 enzyme messenger ribonucleic acid (mRNA) levels. The administration of betamethasone to baboon mothers on days 60-99 of gestation (term = 184 days) decreased fetal pituitary POMC mRNA levels by 54% (P < 0.01) and fetal serum ACTH levels to undetectable values (P < 0.05). The decline in ACTH was associated with decreases in fetal adrenal weight (P < 0.001), cortical cell size (P < 0.05), appearance of apoptosis and cellular disorganization, and a loss of immunocytochemically demonstrable definitive zone-specific delta5-3beta-hydroxysteroid dehydrogenase expression. The concomitant administration of ACTH and betamethasone restored these aspects of adrenal integrity to normal. Moreover, there was approximately a 95% decrease (P < 0.01) in fetal adrenal expression of ACTH receptor, P-450 cholesterol side-chain cleavage, and P-450 17alpha-hydroxylase 17/20-lyase mRNA levels after betamethasone administration. We conclude that fetal pituitary ACTH is necessary for the growth and development of fetal and definitive cortical zones and the marked coordinated increase in ACTH receptor and maintenance of P-450 cholesterol side-chain cleavage/P-450 17alpha-hydroxylase 17/20-lyase expression in the baboon fetal adrenal gland during the first half of gestation.

Effect of Maternal Betamethasone Administration at Midgestation on Baboon Fetal Adrenal Gland Development and Adrenocorticotropin Receptor Messenger Ribonucleic Acid Expression

Effect of Maternal Betamethasone Administration at Midgestation on Baboon Fetal Adrenal Gland Development and Adrenocorticotropin Receptor Messenger Ribonucleic Acid Expression

The short-term effects of maternal betamethasone administration on fetal heart rate

The short-term effects of maternal betamethasone administration on fetal heart rate

The effects of maternal betamethasone administration on the fetus: Derks J.B.; Mulder E.J.H.; Visser G.H.A. NLD Br J Obstet Gynaecol 1995 102/1 (40–46)

International Journal of Gynecology & ObstetricsVolume 52, Issue 1 p. 111-111 Citations from the literature pregnancy and delivery The effects of maternal betamethasone administration on the fetus Derks J.B.; Mulder E.J.H.; Visser G.H.A. NLD Br J Obstet Gynaecol 1995 102/1 (40–46) First published: January 1996 https://doi.org/10.1016/0020-7292(96)82812-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume52, Issue1January 1996Pages 111-111 RelatedInformation

The effects of maternal betamethasone administration on the fetus

To examine prospectively the effects of maternal betamethasone administration on fetal heart rate variation, body, breathing and eye movements and the rest-activity cycle. Thirty-one women on 38 occasions were at risk of premature delivery and received two doses of betamethasone 24 h apart. Gestational age ranged between 26 and 32 weeks. Fetal heart rate was monitored on each of five successive days (0-4) and fetal body, breathing and eye movements were recorded on days 0, 2 and 4. Compared with the control day before steroid administration (day 0), both long term and short term fetal heart rate variation were reduced on days 2 and 3 (P < 0.01). In one-third of the cases, fetal heart rate variation fell transiently below the lower normal range for gestational age. Body movements were reduced on day 2 by 50% (P < 0.01) due to prolonged periods of inactivity (P < 0.01). Breathing movements were largely absent on day 2 (P < 0.01), but the occurrence of eye movements remained unchanged after betamethasone administration. All values returned to baseline on day 4, indicating that no fetal deterioration had occurred during the course of the study period. Similar responses to betamethasone were observed in five fetuses when studied at re-presentation two weeks later. Maternal betamethasone administration causes a considerable but transient reduction in fetal body movements and activity periods, breathing and heart rate variation, without affecting fetal eye movements. Knowledge of this phenomenon is important when assessing the fetal condition. The effect may be due to a glucocorticoid receptor mediated process in the fetal brain.

Transient reduction in fetal activity and heart rate variation after maternal betamethasone administration

We studied the short-term effects of maternal betamethasone administration on fetal well-being by recording of fetal movement and heart rate patterns. In 13 women at high risk of preterm delivery (26–32 weeks), eighty 1-h recordings were made of fetal body and breathing movements and fetal heart rate (FHR) and its variation during 5 consecutive days. Betamethasone was administered in two doses 24 h apart after a control recording had been made. After two doses of betamethasone, fetal body and breathing movements and FHR variation were considerably reduced (P <0.01), but returned to normal after treatment was discontinued. FHR variation was transiently below the lower normal range in 46% of the cases. We conclude that maternal betamethasone administration results in a considerable reduction in fetal movements and FHR variation which may erroneously be interpreted as deterioration of the fetal condition. Knowledge of these transient changes is of significant clinical importance as it may prevent iatrogenic delivery because of suspected fetal distress. The observed effects are possibly mediated by centrally located glucocorticoid receptors.