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The effect of antenatal corticosteroid use on offspring cardiovascular function: A systematic review
Adalina Sacco1,2, Emily F Cornish1, Neil Marlow1
1Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
Insights
Antenatal corticosteroids (ACS) did not show significant long-term effects on blood pressure in human offspring. However, the impact of ACS on cardiac structure and function requires further investigation due to limited data.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Cardiovascular Research
Background:
- Antenatal corticosteroids (ACS) are crucial for preterm labor to improve neonatal outcomes.
- Preclinical studies suggest potential adverse effects of ACS on offspring cardiac development, but human data are lacking.
Approach:
- A systematic review of human clinical literature was conducted following PRISMA guidelines.
- MEDLINE, EMBASE, and Cochrane databases were searched for relevant studies.
- Twenty-six studies involving 1921 patients were included to assess cardiovascular function in offspring exposed to ACS.
Key Points:
- No clinically significant effects of ACS exposure were observed on offspring blood pressure.
- Arterial blood pressure was the most frequently assessed cardiovascular parameter.
- Studies assessing cardiac structure and function via echocardiography or cardiac MRI were insufficient to draw conclusions.
Conclusions:
- ACS administration is not linked to long-term blood pressure effects in human offspring.
- The impact of ACS on cardiac structure and function remains unclear due to study limitations.
- Further research is needed to evaluate the central cardiac function in human offspring exposed to ACS.
Background:
Antenatal corticosteroids (ACS) are recommended in threatened preterm labour to improve short-term neonatal outcome. Preclinical animal studies suggest detrimental effects of ACS exposure on offspring cardiac development; their effects in humans are unknown.
Objectives:
To systematically review the human clinical literature to determine the effects of ACS on offspring cardiovascular function.
Search Strategy:
A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in MEDLINE, EMBASE and Cochrane databases.
Selection Criteria:
Offspring who had been exposed to ACS during fetal life, in comparison with those not receiving steroids, those receiving a placebo or population data, were included. Studies not performed in humans or that did not assess cardiovascular function were excluded.
Data Collection And Analysis:
Two authors independently screened the studies, extracted the data and assessed the quality of the studies. Results were combined descriptively and analysed using a standardised Excel form.
Main Results:
Twenty-six studies including 1921 patients were included, most of which were cohort studies of mixed quality. The type of ACS exposure, gestational age at exposure, dose and number of administrations varied widely. Offspring cardiovascular outcomes were assessed from 1 day to 36 years postnatally. The most commonly assessed parameter was arterial blood pressure (18 studies), followed by echocardiography (eight studies), heart rate (five studies), electrocardiogram (ECG, three studies) and cardiac magnetic resonance imaging (MRI, one study). There were no clinically significant effects of ACS exposure on offspring blood pressure. However, there were insufficient studies assessing cardiac structure and function using echocardiography or cardiac MRI to be able to determine an effect.
Conclusions:
The administration of ACS is not associated with long-term effects on blood pressure in exposed human offspring. The effects on cardiac structure and other measures of cardiac function were unclear because of the small number, heterogeneity and mixed quality of the studies. Given the preclinical and human evidence of potential harm following ACS exposure, there is a need for further research to assess central cardiac function in human offspring exposed to ACS.
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