Prenatal Glucocorticoid Treatment Completeness and Steroid Hormonal Levels as Related to Infant and Maternal Health.
Prenatal Glucocorticoid Treatment Completeness and Steroid Hormonal Levels as Related to Infant and Maternal Health.
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产前糖皮质激素治疗的完整性和类固醇激素水平与婴儿和孕产妇健康相关。
DOI：
10.1097/jpn.0000000000000519
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Holditch-Davis,Diane
中科院分区：
文献类型：
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作者：
Cho,June;Chien,Lung-Chang;Holditch-Davis,Diane
本研究旨在证实在控制产前糖皮质激素（GC）治疗后，极低出生体重（VLBW）婴儿的睾酮和皮质醇水平与健康和发育结局之间存在负相关。从美国东南部的新生儿重症监护病房招募了74对VLBW婴儿-母亲。我们将这些对分为完全（n= 58）和不完全（n= 16）GC治疗组。婴儿和母亲的数据在出生时，40周月经后年龄，3个月和6个月的矫正年龄。唾液睾酮和皮质醇水平的对测定在40周postmenstrual年龄使用酶免疫测定法。对数线性和一般线性混合模型表明，孕龄和出生体重较低时，睾酮是1 pg/mL的高。当皮质醇高于1 μg/dL时，出院时的技术依赖性较高，6个月时的运动发育较低。完全GC治疗的母亲有更大的产次和妊娠，更多的产前检查，更多的医疗并发症。研究结果支持了我们的假设，即类固醇激素水平比GC治疗的完整性更能预测婴儿的健康和发育。单剂量GC治疗可能与2次给药一样有效，但需要更多受试者的进一步研究来证实。由于与类固醇激素水平的相关性持续时间长于GC治疗相关性，我们建议在6个月后确认睾酮和皮质醇水平的预测作用。
This study was conducted to confirm the negative associations between testosterone and cortisol levels and health and developmental outcomes in very low-birth weight (VLBW) infants after controlling for prenatal glucocorticoid (GC) treatment. Seventy-four VLBW infant-mother pairs were recruited from a neonatal intensive care unit in the Southeastern United States. We divided the pairs into the complete (n= 58) and incomplete (n= 16) GC treatment groups. Data on infants and mothers were obtained at birth, 40 weeksʼ postmenstrual age, and 3 and 6 monthsʼ corrected age. Salivary testosterone and cortisol levels of the pairs were determined at 40 weeksʼ postmenstrual age using enzyme immunoassay. Log-linear and general linear mixed models showed that gestational age and birth weight were lower when testosterone was 1 pg/mL higher. When cortisol was 1 μg/dL higher, technology dependence at discharge was higher and motor development at 6 months was lower. Mothers with complete GC treatment had greater parity and gravida, more prenatal visits, and more medical complications. The study outcomes supported our hypothesis that steroid hormonal levels are more predictive of infant health and development than GC treatment completeness. Single dose of GC treatment might be just as effective as 2 doses, although further study with more subjects would be needed to confirm. As the associations with steroid hormonal levels lasted longer than the GC treatment associations, we recommend confirming the predictive effects of testosterone and cortisol levels after 6 months.