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Obstet Gynecol. 2012 May;119(5):917-23. doi: 10.1097/AOG.0b013e31825189dc.

Effect of antenatal corticosteroids on fetal growth and gestational age at birth.

Collaborators (229)

Kwiatkowski L, Tortorella SM, Bertin MS, Castaldi JL, Deguer C, Klun M, Besegato C, Izbizky G, Vaneri MC, Fustinana CA, Otano L, Palermo MS, Murua EJ, Valera DM, Sampietro H, Monaco A, Savransky R, Dunaiewsky A, Basualdo MN, Andina E, Di Marco I, Rivero M, Feu MC, Garcia S, Aguirre JD, Morales EM, Ayala LE, De Sagastizabal MT, Abreo G, Uranga A, Martin Rde L, Arias C, Gorostiaga RA, Curioni M, Alvarado J, Fuchtner C, Flores DM, Tessari DM, Madi JM, de Lorenzi DR, Mattana Mdo C, Brunstein C, Trapani A Jr, Schmaltz L, de Souza GR, de Assis ME, Melgaco IA, de Sa RA, Bornia RG, Demianczuk NN, Penttinen E, Butt K, Hay K, Sandwich V, Armson BA, Vincer M, Allen V, Fanning C, Kulkarni R, Carson GD, Williams S, Holfeld S, Olatunbosun F, Dalton S, Henry A, Haughian J, Moutquin JM, Blouin D, Bedard SK, Murphy K, Ohlsson A, Kelly E, Jordan A, Shapiro J, Asztalos E, Barrett J, Cohen H, Andrews L, Owen H, Delisle MF, Popovska V, Soanes S, Helewa ME, Kenny-Lodewyks D, Gomez R, Silva K, Poblete JF, Ferrand P, Belmar C, Vera C, Su QF, Gu W, Liu ZW, Flores MM, Santoro CM, Ortiz EI, Torres J, Rodriguez A, Hvidman L, Mouritzen A, Vikre-Jørgensen J, Hopp H, Nonnenmacher A, Braig U, Berg C, Bizjak G, Gembruch U, Schwarzer V, Hoyme UB, Bittrich HJ, Oletzky B, Schneider J, Hollwitz B, Oehler K, Dressler F, Ertan AK, Hentschel J, Mack A, Schmidt W, Faber R, Stepan H, Kuhnert M, Stiller S, Kuschel B, Schneider KT, Zimmermann A, Krause M, Grobe H, Terzioglu N, Seelbach-Goebel B, Falkert A, Mueller K, Voss H, Major T, Zoárd K, Bartha T, Bea P, Zsadány J, Nachum Z, Peniakov M, Hallak M, Harlev A, Harel L, Chayen B, Siev S, Samberg I, Wolff L, Sadan O, Elyassi A, Baider C, Kohelet D, Golan A, Mankuta D, Bar-Oz B, Combs D, Rosen DJ, Kaneti HY, Tzachi T, Zausmer J, Maman M, Perri T, Taitelboum S, Simchen M, Shalev G, Goldinfeld M, Levine O, El-Zibdeh MY, Al-Faris LT, Ayyash HA, Ugarte PS, Preis K, Domzalska-Popadiuk I, Swiatkowska-Freund M, Janczewska I, Wilczynski J, Krekora M, Kesiak M, Gulczyńska E, Ropacka M, Madejczyk M, Rozycka J, Breborowicz GH, Szymankiewicz M, Borzova N, Posiseeva LV, Khodjaeva Z, Vikhlyaeva E, Palacio M, Salvia D, Botet F, Massanes M, Lopez M, Hösli I, Holzgreve W, Voekt CA, Belhia F, Hohlfeld P, Prince-dit-Clottu E, Beinder E, von Mandach U, Fauchere JC, Roumen FJ, Pieters M, Smits F, Bolaji II, Adiotomre P, Al-Taher H, Barnes H, Abdul-Kadir R, Chi C, Van Someren V, Dexter S, Samelson R, Horgan MJ, Valentini C, Pardanani S, Bebbington M, Chazotte C, Kilpatrick S, Drahos JL, Saldana L, Mount B, Warner B, Wedig K, Lysikiewicz A, Bsat F, Fleming J, Lee A, Hoffman D.

Abstract

OBJECTIVE:

To estimate the effect of multiple courses of antenatal corticosteroids on neonatal size, controlling for gestational age at birth and other confounders, and to determine whether there was a dose-response relationship between number of courses of antenatal corticosteroids and neonatal size.

METHODS:

This is a secondary analysis of the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study, a double-blind randomized controlled trial of single compared with multiple courses of antenatal corticosteroids in women at risk for preterm birth and in which fetuses administered multiple courses of antenatal corticosteroids weighed less, were shorter, and had smaller head circumferences at birth. All women (n=1,858) and children (n=2,304) enrolled in the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study were included in the current analysis. Multiple linear regression analyses were undertaken.

RESULTS:

Compared with placebo, neonates in the antenatal corticosteroids group were born earlier (estimated difference and confidence interval [CI]: -0.428 weeks, CI -0.10264 to -0.75336; P=.01). Controlling for gestational age at birth and confounding factors, multiple courses of antenatal corticosteroids were associated with a decrease in birth weight (-33.50 g, CI -66.27120 to -0.72880; P=.045), length (-0.339 cm, CI -0.6212 to -0.05676]; P=.019), and head circumference (-0.296 cm, -0.45672 to -0.13528; P<.001). For each additional course of antenatal corticosteroids, there was a trend toward an incremental decrease in birth weight, length, and head circumference.

CONCLUSION:

Fetuses exposed to multiple courses of antenatal corticosteroids were smaller at birth. The reduction in size was partially attributed to being born at an earlier gestational age but also was attributed to decreased fetal growth. Finally, a dose-response relationship exists between the number of corticosteroid courses and a decrease in fetal growth. The long-term effect of these findings is unknown.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00187382.

LEVEL OF EVIDENCE:

II.

PMID:
22525902
[PubMed - indexed for MEDLINE]
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