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steroids in fetal lung maturity

Carole R Mendelson, Alina P Montalbano, Lu Gao
Preterm birth remains the major cause of neonatal morbidity and mortality throughout the world. This is due, in part, to our incomplete understanding of the mechanisms that underlie the maintenance of pregnancy and the initiation of parturition at term. In this article, we review our current knowledge of the complex, interrelated and concerted mechanisms whereby progesterone maintains myometrial quiescence throughout most of pregnancy, as well as those that mediate the upregulation of the inflammatory response and decline in progesterone receptor function leading to parturition...
September 11, 2016: Journal of Steroid Biochemistry and Molecular Biology
Carolyn I Freeman, Natasha L Hezelgrave, Andrew H Shennan
Antenatal corticosteroids for fetal lung maturation have become mainstay treatment in women thought to be at high-risk of premature birth. To ensure treatment efficacy before delivery, the current practice is to administer steroids early to a woman considered at risk; however, neonatal benefit is lost after the seven-day treatment-to-delivery window. Over half of women who deliver before 34 weeks' gestation do not receive antenatal corticosteroids within this timeframe, but many still deliver prematurely; however, clinicians are reluctant to administer repeated courses of steroids due to concerns, among others, of impaired fetal growth...
December 2015: Obstetric Medicine
Vanessa A Fravel, Linda J Lowenstine, Amanda Koehne
A wild-born, captive-reared, 14 yr old, primiparous female California sea lion Zalophus californianus presented for anorexia of 14 d duration and abdominal distention. Routine complete blood cell count revealed leukocytosis with a neutrophilia, and serum chemistry revealed hypoalbumenemia and hyponatremia. Treatment with broad spectrum antibiotics and non-steroidal anti-inflammatories were started, but the animal continued to decline. Abdominal radiographs revealed a mature mineralized fetal skull and spine in the caudal abdomen and abdominal ultrasound revealed ascites but could not confirm the fetus...
July 7, 2016: Diseases of Aquatic Organisms
Thomas J Wood, Daniel J Hoppe, Mitchell Winemaker, Anthony Adili
Osteonecrosis of the femoral head during pregnancy, or shortly thereafter, is a rare clinical problem. Little is known about pregnancy as an etiological factor for femoral head osteonecrosis with only 40 reported cases in the literature. Furthermore, single or dual dose steroid-induced multifocal osteonecrosis is a controversial topic with only a handful of published cases. We present a case of a 34-year-old female with bilateral femoral head osteonecrosis that developed during the peripartum period. She received two large intramuscular injections of steroids for fetal lung maturity because early delivery was required as a result of eclampsia...
2016: Curēus
L van de Mheen, A C Ravelli, M A Oudijk, S Nij Bijvank, M M Porath, J J Duvekot, M A G Holswilder-Olde Scholtenhuis, K W M Bloemenkamp, H C J Scheepers, M Woiski, M G van Pampus, C J de Groot, E Pajkrt, B W J Mol
Objective Some clinicians advise prophylactic administration of antenatal steroids for fetal lung maturation in women with a triplet pregnancy. However, the effect of corticosteroids is limited to 10 to 14 days after administration. The aim of this study was to assess the natural course of triplet pregnancies to allow a better anticipation for administration of corticosteroids. Study Design We collected data on all triplet pregnancies in the Netherlands from 1999 to 2007 from the Netherlands Perinatal Registration...
May 11, 2016: American Journal of Perinatology
Jiunn-Ming Sheen, Chih-Sung Hsieh, You-Lin Tain, Shih-Wen Li, Hong-Ren Yu, Chih-Cheng Chen, Miao-Meng Tiao, Yu-Chieh Chen, Li-Tung Huang
Increasing evidence has shown that many chronic diseases originate from early life, even before birth, through what are termed as fetal programming effects. Glucocorticoids are frequently used prenatally to accelerate the maturation of the lungs of premature infants. High-fat diets are associated with insulin resistance, but the effects of prenatal glucocorticoid exposure plus a postnatal high-fat diet in diabetes mellitus remain unclear. We administered pregnant Sprague-Dawley rats' intraperitoneal dexamethasone (0...
2016: International Journal of Molecular Sciences
Zarqa Saif, Rebecca M Dyson, Hannah K Palliser, Ian M R Wright, Nick Lu, Vicki L Clifton
The placental glucocorticoid receptor (GR) is central to glucocorticoid signalling and for mediating steroid effects on pathways associated with fetal growth and lung maturation but the GR has not been examined in the guinea pig placenta even though this animal is regularly used as a model of preterm birth and excess glucocorticoid exposure. Guinea pig dams received subcutaneous injections of either vehicle or betamethasone at 24 and 12 hours prior to preterm or term caesarean-section delivery. At delivery pup and organ weights were recorded...
2016: PloS One
David M Haas, Dongbing Lai, Sunita Sharma, Jenny Then, Alvin Kho, David A Flockhart, Kelan Tantisira, Tatiana Foroud
OBJECTIVE: To test several key glucocorticoid genes that are enhanced in lung development for associations with respiratory distress syndrome (RDS) after antenatal corticosteroid use. METHODS: A prospective cohort of women received betamethasone to accelerate fetal lung maturity for threatened preterm delivery. DNA was obtained from mothers and newborns. Neonatal RDS was the primary outcome. Genotyping for single-nucleotide polymorphisms (SNPs) in 68 glucocorticoid genes found to be differentially expressed during lung development was performed...
May 2016: Reproductive Sciences
William Lindsley, Richard Hale, Ashley Spear, Jasvant Adusumalli, Jasbir Singh, Kimberly DeStefano, Sina Haeri
AIM: Maternal corticosteroid administration in pregnancy is known to enhance fetal lung maturity in at risk fetuses. The aim of this study was to test the hypothesis that corticosteroid therapy alters fetal pulmonary blood flow in pregnancies at risk for preterm birth (PTB). MATERIAL AND METHODS: We prospectively evaluated main fetal pulmonary artery (MPA) blood flow in pregnant women at risk for PTB and treated with corticosteroids (betamethasone), compared to an uncomplicated cohort without steroid therapy...
September 2015: Medical Ultrasonography
Till Kaltofen, Melanie Haase, Ulrich H Thome, Mandy Laube
Respiratory distress syndrome (RDS) is the most frequent pulmonary complication in preterm infants. RDS incidence differs between genders, which has been called the male disadvantage. Besides maturation of the surfactant system, Na+ transport driven alveolar fluid clearance is crucial for the prevention of RDS. Na+ transport is mediated by the epithelial Na+ channel (ENaC) and the Na,K-ATPase, therefore potential differences in their expression or activity possibly contribute to the gender imbalance observed in RDS...
2015: PloS One
Shirlene Sim, Fabricio Da Silva Costa, Edward Araujo Júnior, Penelope M Sheehan
OBJECTIVE: To determine the predictive value of various cervical length measurements postcerclage for the outcome of preterm birth following both elective and rescue cerclage. MATERIALS AND METHODS: Over a five-year period, we identified 59 women who had a transvaginal cerclage inserted followed by serial cervical length measurement. Of these, 18 were elective cerclages placed at 14 weeks of gestation on the basis of a history of cervical insufficiency and 41 were rescue cerclages performed at gestations ranging from 17 to 23 weeks following a diagnosis of shortened cervix on ultrasound...
August 2015: Australian & New Zealand Journal of Obstetrics & Gynaecology
Ernawati, Erry Gumilar, Kuntoro, Joewono Soeroso, Gus Dekker
OBJECTIVE: To present the outcome of expectant management of preterm preeclampsia in Indonesia, and the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal outcome. MATERIAL AND METHODS: Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration of dexamethasone for fetal lung maturation, patients were randomized to receive 25 mg MP group IV for the first week, decreasing to 12.5 mg during 2nd week and continued till birth, or matching IV placebo treatment (PL group)...
2016: Journal of Maternal-fetal & Neonatal Medicine
Lu Gao, Elizabeth H Rabbitt, Jennifer C Condon, Nora E Renthal, John M Johnston, Matthew A Mitsche, Pierre Chambon, Jianming Xu, Bert W O'Malley, Carole R Mendelson
The precise mechanisms that lead to parturition are incompletely defined. Surfactant protein-A (SP-A), which is secreted by fetal lungs into amniotic fluid (AF) near term, likely provides a signal for parturition; however, SP-A-deficient mice have only a relatively modest delay (~12 hours) in parturition, suggesting additional factors. Here, we evaluated the contribution of steroid receptor coactivators 1 and 2 (SRC-1 and SRC-2), which upregulate SP-A transcription, to the parturition process. As mice lacking both SRC-1 and SRC-2 die at birth due to respiratory distress, we crossed double-heterozygous males and females...
July 1, 2015: Journal of Clinical Investigation
Emily Baker, Tiffany Hunter, Nanette Okun, Dan Farine
OBJECTIVE: We sought to determine the interventions utilized by maternal-fetal medicine specialists in the prediction and prevention of preterm labor in higher-order multiple (HOM) gestations. STUDY DESIGN: Online questionnaires and email surveys were sent to all the maternal-fetal medicine specialists in Canada (n=122). Questionnaire items included interventions physicians routinely recommended for HOM gestations including: (1) bed rest; (2) cervical length measurement on transvaginal ultrasound; (3) corticosteroids use; (4) cerclage; and (5) tocolytic therapy...
May 2015: American Journal of Obstetrics and Gynecology
A Daniel Bird, Annie R A McDougall, Bennet Seow, Stuart B Hooper, Timothy J Cole
Glucocorticoid (GC) steroid hormones have well-characterized roles in the regulation of systemic homeostasis, yet less understood is their known role in utero to mature the developing respiratory system in preparation for birth. During late gestation, endogenously produced GCs thin the interstitial tissue of the lung, causing the vasculature and future airspaces to come into close alignment, allowing for efficient gas exchange at birth. More potent synthetic GCs are also used worldwide to reduce the severity of respiratory distress suffered by preterm infants; however, their clinical benefits are somewhat offset by potential detrimental long-term effects on health and development...
February 2015: Molecular Endocrinology
Jamie O Lo, Brian L Shaffer, Allison J Allen, Sarah E Little, Yvonne W Cheng, Aaron B Caughey
OBJECTIVE: We examined the morbidities from delivery at earlier gestational ages versus intrauterine fetal demise (IUFD) for women with intrahepatic cholestasis of pregnancy (ICP) to determine the optimal gestational age for delivery. METHODS: A decision-analytic model was created to compare delivery at 35 through 38 weeks gestation for different delivery strategies: (1) empiric steroids; (2) steroids if fetal lung maturity (FLM) negative; (3) wait a week and retest if FLM negative; or (4) deliver immediately...
2015: Journal of Maternal-fetal & Neonatal Medicine
Nadia Falah, David M Haas
Landmark early work has led to the nearly universal use of antenatal corticosteroids to accelerate fetal lung maturity with pregnancies complicated by impending preterm birth. Antenatal corticosteroids clearly reduce respiratory morbidity, death, and other adverse neonatal outcomes. Limited pregnant human pharmacokinetic data and some animal data give clinicians some information as to the behavior of the drug in the body. However, there is controversy about the type, amount, and frequency of steroid to use for this therapy...
December 2014: Seminars in Perinatology
Carolin Schmidt, Jürgen Klammt, Ulrich H Thome, Mandy Laube
PURPOSE: Glucocorticoids and progesterone exert stimulatory effects on epithelial Na(+) transport, including increased mRNA expression of the participating ion transporters (epithelial Na(+) channels [ENaC] and Na,K-ATPases) and their electrophysiological activity. Fetuses threatened by preterm labor may receive high doses of glucocorticoids to stimulate lung maturation and are naturally exposed to high levels of female sex steroids. However, it is still unknown how the combination of both hormones influences the epithelial Na(+) transport, which is crucial for alveolar fluid clearance...
December 2014: Lung
Joshua P Vogel, Juan Manuel Nardin, Therese Dowswell, Helen M West, Olufemi T Oladapo
BACKGROUND: Preterm birth represents the single largest cause of mortality and morbidity for newborns and a major cause of morbidity for pregnant women. Tocolytic agents include a wide range of drugs that can inhibit labour to prolong pregnancy. This may gain time to allow the fetus to mature further before being born, permit antenatal corticosteroid administration for lung maturation, and allow time for intra-uterine transfer to a hospital with neonatal intensive care facilities. However, some tocolytic drugs are associated with severe side effects...
2014: Cochrane Database of Systematic Reviews
G B Sadowska, B S Stonestreet
Gap junctions facilitate intercellular communication and are important in brain development. Connexins (Cx) comprise a transmembrane protein family that forms gap junctions. Cx-32 is expressed in oligodendrocytes and neurons, Cx-36 in neurons, and Cx-43 in astrocytes. Although single antenatal steroid courses are recommended for fetal lung maturation, multiple courses can be given to women at recurrent risk for premature delivery. We examined the effects of single and multiple glucocorticoid courses on Cx-32, Cx-36, and Cx-43 protein expressions in the fetal cerebral cortex, cerebellum, and spinal cord, and differences in Cx expression among brain regions under basal conditions...
September 5, 2014: Neuroscience
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