Bone metabolism in pregnant women exposed to single compared with multiple courses of corticosteroids.
OBJECTIVE
To compare markers of maternal bone metabolism between women who received a single compared with multiple courses of antenatal corticosteroids.


METHODS
This is an analysis of serum samples from a previously reported randomized, placebo-controlled, multicenter trial. Women at risk for preterm delivery after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone (active) or placebo. Serum levels of carboxy terminal propeptide of type I procollagen (PICP) and cross-linked carboxy terminal telopeptide of type I collagen (ICTP) were measured to assess the rate of bone formation and resorption, respectively, at three time points. The placebo group (n=93) was compared with the active group, receiving four or more courses of betamethasone (n=112).


RESULTS
There were significant (P<.001) increases in PICP and ICTP between baseline and delivery in both groups. Cross-linked carboxy terminal telopeptide of type I collagen, but not PICP, was lower with corticosteroid exposure immediately before administration of the fourth study course (P<.001). No significant differences in PICP and ICTP were seen between groups at delivery.


CONCLUSIONS
Increasing levels of PICP and ICTP with advancing gestation are consistent with physiologic changes in maternal bone metabolism. Multiple courses of corticosteroids for fetal maturation are not associated with persistent or cumulative effects on maternal bone metabolism as measured by PICP and ICTP.


METHODS
II.
Carroll
Mary A
MA
Department of Obstetrics and Gynecology, University of Texas Houston, Houston, Texas 77030, USA.
Vidaeff
Alex C
AC
Mele
Lisa
L
Wapner
Ronald J
RJ
Mercer
Brian
B
Peaceman
Alan M
AM
Sorokin
Yoram
Y
Dudley
Donald J
DJ
Spong
Catherine Y
CY
Leveno
Kenneth J
KJ
Harper
Margaret
M
Caritis
Steve N
SN
Miodovnik
Menachem
M
Thorp
John M
JM
Moawad
Atef
A
O'Sullivan
Mary J
MJ
Carpenter
Marshall W
MW
Rouse
Dwight J
DJ
Sibai
Baha
B
D001623:Betamethasone / Q000008:administration & dosage* / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood*; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D024042:Collagen Type I / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D010446:Peptide Fragments / Q000097:blood*; D010455:Peptides / Q000097:blood*; D011247:Pregnancy; D011347:Procollagen / Q000097:blood*
D015415:Biomarkers; D024042:Collagen Type I; D005938:Glucocorticoids; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C042813:procollagen type I carboxy terminal peptide; D001623:Betamethasone