title: Antenatal corticosteroids and the renin-angiotensin-aldosterone system in adolescents born preterm.
abstract: Antenatal corticosteroid (ANCS) treatment hastens fetal lung maturity and improves survival of premature infants, but the long-term effects of ANCS are not well-described. Animal models suggest that ANCS increases the risk of cardiovascular disease through programmed changes in the renin-angiotensin (Ang)-aldosterone system (RAAS). We hypothesized that ANCS exposure alters the RAAS in adolescents born prematurely.
  
  
  
  A cohort of 173 adolescents born prematurely was evaluated, of whom 92 were exposed to ANCS. We measured plasma and urine Ang II and Ang-(1-7) and calculated Ang II/Ang-(1-7) ratios. We used general linear regression models to estimate the difference in the RAAS between the ANCS-exposed and unexposed groups, adjusting for confounding variables.
  
  
  
  In unadjusted analyses, and after adjustment for sex, race, and maternal hypertension, ANCS exposure was associated with increased urinary Ang II/Ang-(1-7) (estimate 0.27 (95% CI 0.03, 0.5), P = 0.03), increased plasma Ang-(1-7) (0.66 (0.26, 1.07), P = 0.002), and decreased plasma Ang II/Ang-(1-7) (-0.48 (-0.91, -0.06), P = 0.03).
  
  
  
  These alterations indicate an imbalance in the urinary RAAS, promoting the actions of Ang II at the expense of Ang-(1-7), which over time may increase the risk of renal inflammation and fibrosis and ultimately hypertension and renal disease.
authors.affiliation: Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina.|Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: South
authors.affiliation: Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina.|Department of Health and Exercise Science, Wake Forest University, Winston Salem, North Carolina.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Nixon
authors.affiliation: Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina.|Department of Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Chappell
authors.affiliation: Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina.|Department of Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Debra I
authors.initials: DI
authors.lastname: Diz
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Russell
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Beverly M
authors.initials: BM
authors.lastname: Snively
authors.affiliation: Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina.|Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Hossam A
authors.initials: HA
authors.lastname: Shaltout
authors.affiliation: Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: James C
authors.initials: JC
authors.lastname: Rose
authors.affiliation: Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina.|Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.affiliation: Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, North Carolina.|Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Washburn
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000803:Angiotensin I / Q000097:blood / Q000652:urine; D000804:Angiotensin II / Q000097:blood / Q000652:urine; D015331:Cohort Studies; D005260:Female; D005325:Fetal Organ Maturity / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010446:Peptide Fragments / Q000097:blood / Q000652:urine; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology*; D012083:Renin / Q000097:blood / Q000652:urine; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology
chemical_list: D000305:Adrenal Cortex Hormones; D010446:Peptide Fragments; D000804:Angiotensin II; D000803:Angiotensin I; D012083:Renin; C118790:angiotensin I (1-7)