Exposure to repeat doses of antenatal glucocorticoids is associated with altered cardiovascular status after birth.
OBJECTIVE
To determine if exposure to more than one course of antenatal glucocorticoids is associated with changes in infant blood pressure and myocardial wall thickness in the first month after birth.


METHODS
Prospective cohort study.


METHODS
Tertiary neonatal intensive care unit.


METHODS
Mothers who were eligible for but declined to enter a randomised trial of repeated doses of antenatal glucocorticoids (ACTORDS)-that is, who had a singleton, twin, or triplet pregnancy at <32 weeks gestation, had received an initial course of glucocorticoids seven or more days previously, and were considered to be at continued risk of preterm birth.


METHODS
Blood pressure daily for the first week then weekly until 4 weeks of age. End diastolic interventricular septal and left ventricular posterior wall (EDIVS and EDLVPW) thickness at 48-72 hours after birth.


RESULTS
Thirty seven women were enrolled and delivered 50 infants. Thirty mothers (39 infants) were exposed to one course of glucocorticoids, and seven mothers (11 infants) to more than one course. Blood pressures were higher in the first week after birth in infants exposed to multiple courses of glucocorticoids, and in infants with a latency between last exposure and delivery of less than seven days. Systolic blood pressure on day 1 was >2SD above published normal ranges in 67% of babies exposed to multiple courses and 24% of babies exposed to a single course of glucocorticoids (p = 0.04). There was no difference between groups in thickness of the EDIVS or EDLVPW. However, 44/50 (88%) babies had EDIVS and 49/50 (98%) babies had EDLVPW thickness >2 SD above the expected mean for birth weight and gestation. EDIVS but not EDLVPW thickness increased with increasing latency (mean 0.02 mm/day, p = 0.03).


CONCLUSIONS
Future randomised trials should assess the long term effects of exposure to antenatal glucocorticoids, particularly multiple courses, on the cardiovascular status of the infant.
Mildenhall
L F J
LF
Kidz First Middlemore Hospital, Auckland, New Zealand.
Battin
M R
MR
Morton
S M B
SM
Bevan
C
C
Kuschel
C A
CA
Harding
J E
JE
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects*; D006332:Cardiomegaly / Q000139:chemically induced*; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006321:Heart / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000139:chemically induced; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects
D005938:Glucocorticoids