title: Effect of corticosteroids on cardiac function in growth-restricted fetuses.
abstract: OBJECTIVE
  To determine the acute effects of corticosteroids on the cardiovascular system in growth-restricted fetuses.
  
  
  METHODS
  This was a prospective cohort study conducted at a tertiary hospital between January 2011 and October 2013. Fetal cardiovascular function in fetuses with intrauterine growth restriction (IUGR) was assessed immediately before and 24 h after the first dose of betamethasone, administered in routine management of IUGR. Fetal arterial and venous Dopplers were assessed. Fetal cardiac function was evaluated by tissue Doppler echocardiography, with the assessment of both left and right ventricular function by calculating myocardial performance index (MPI') and E':A' ratios. Values were compared before and after exposure.
  
  
  RESULTS
  Seventeen patients were included at a mean gestational age of 34 + 1 (range, 29 + 1 to 37 + 4) weeks. Fifteen fetuses were below the 5(th) percentile and two were below the 10(th) percentile for estimated fetal weight and abdominal circumference and all had no interval growth during a 2-week period. There was a decrease in right MPI' (from 0.56 to 0.47; P = 0.007) after corticosteroid exposure but no change in left MPI' (from 0.49 to 0.48). Right MPI' was higher than left MPI' before exposure (0.56 vs 0.49, respectively; P = 0.001), but not after exposure (P = 0.55). There was no change in left or right ventricular E':A' ratios and no difference was detected in umbilical artery, middle cerebral artery or ductus venosus pulsatility index following administration of corticosteroids.
  
  
  CONCLUSIONS
  Corticosteroids altered right-sided, but not left-sided, tissue Doppler MPI' in IUGR fetuses, with no detectable change in arterial or venous Doppler pulsatility indices. Before exposure, the mean right MPI' was higher than the left. However, after exposure, there was no difference, suggesting that corticosteroids may reverse the negative effect of IUGR on fetal heart function. Large prospective studies with a larger sample size are needed to confirm this finding. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia.|Department of Clinical Medicine, Obstetrics and Gynecology, Aarhus University, Aarhus, Denmark.
authors.forename: L H
authors.initials: LH
authors.lastname: Pedersen
authors.affiliation: Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia.|Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Mogra
authors.affiliation: Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia.|Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Hyett
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D005865:Gestational Age; D006334:Heart Function Tests / Q000187:drug effects*; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods
chemical_list: D000305:Adrenal Cortex Hormones; D001623:Betamethasone
keywords: E′:A′ ratio; intrauterine growth restriction; myocardial performance index; prenatal ultrasound