Exposure to repeat doses of antenatal glucocorticoids is associated with altered cardiovascular status after birth

Lindsay F J Mildenhall ¹, Malcolm R Battin ², Susan MB Morton ², Coila Bevan ², Carl A Kuschel ³ and Jane E Harding ^2*

¹ Kidz First Middlemore Hospital, New Zealand
² University of Auckland, New Zealand
³ National Women's Hospital, New Zealand

^* To whom correspondence should be addressed. E-mail: j.harding{at}auckland.ac.nz.

Accepted 19 August 2005

Abstract

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.

Design:Prospective cohort study

Setting:Tertiary Neonatal Intensive Care Unit

Participants:Mothers who were eligible for but declined to enter a randomised trial of repeated doses of antenatal glucocorticoids (ACTORDS) i.e. 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.

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

Results:Thirty seven women were enrolled and delivered 50 infants. Thirty mothers (39 infants) were exposed to one course of glucocorticoids and 7 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 7 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 birthweight and gestation. EDIVS but not EDLVPW thickness increased with increasing latency (mean 0.02mm per day, p = 0.03).

Conclusion:Future randomised trials should assess the longterm effects of exposure to antenatal glucocorticoids, and particularly multiple courses, on the cardiovascular status of the infant.

Keywords: blood pressure, corticosteroids, premature, cardiac hypertrophy

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