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Published on: June 29, 2013
Effect of corticosteroids on cardiac function in growth-restricted fetuses
L H Pedersen1,2, R Mogra1,3, J Hyett1,3
1Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia.
Insights
Corticosteroids improved fetal heart function in growth-restricted fetuses by altering right-sided myocardial performance index (MPI) without affecting left-sided function or Doppler indices. Further research is needed to confirm these findings.
Area of Science:
- Perinatology
- Fetal Cardiology
- Reproductive Medicine
Background:
- Intrauterine growth restriction (IUGR) poses significant risks to fetal cardiovascular health.
- Corticosteroid therapy is used in managing IUGR, but its acute cardiovascular effects require elucidation.
- Understanding these effects is crucial for optimizing fetal well-being in high-risk pregnancies.
Purpose of the Study:
- To investigate the immediate impact of corticosteroid administration on the cardiovascular system of fetuses diagnosed with IUGR.
- To assess changes in fetal cardiac function, specifically ventricular performance, following betamethasone exposure.
- To evaluate alterations in arterial and venous Doppler indices post-corticosteroid treatment.
Main Methods:
- Prospective cohort study involving 17 IUGR fetuses at a tertiary hospital.
- Fetal cardiovascular function assessed using tissue Doppler echocardiography (MPI', E':A' ratios) and Doppler ultrasound (arterial, venous indices) before and 24 hours after the first betamethasone dose.
- Comparison of cardiac function parameters and Doppler indices pre- and post-corticosteroid exposure.
Main Results:
- A significant decrease in right ventricular myocardial performance index (MPI') was observed post-corticosteroid exposure (P=0.007).
- No significant changes were detected in left ventricular MPI' or E':A' ratios for either ventricle.
- Umbilical, middle cerebral, and ductus venosus Doppler pulsatility indices remained unchanged after betamethasone administration.
Conclusions:
- Corticosteroids acutely alter right-sided cardiac function (MPI') in IUGR fetuses, suggesting a potential benefit.
- The observed normalization of right vs. left MPI' suggests a reversal of IUGR-related cardiac dysfunction.
- Larger prospective studies are warranted to validate these preliminary findings on corticosteroid effects in IUGR.
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.
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