Cardiovascular risk factors after antenatal exposure to betamethasone: 30-year follow-up of a randornised controlled trial
Cardiovascular risk factors after antenatal exposure to betamethasone: 30-year follow-up of a randornised controlled trial
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DOI：
10.1016/s0140-6736(05)66617-2
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发表时间：
2005-05-28
期刊：
影响因子：
168.9
通讯作者：
Harding, JE
中科院分区：
文献类型：
--
作者：
Dalziel, SR;Walker, NK;Harding, JE
围产儿呼吸窘迫综合征的治疗广泛用于预防早产儿的新生儿呼吸窘迫综合征，并大大降低新生儿的死亡率和发病率。胎儿暴露于过量的糖皮质激素已被认为是成人疾病胎儿起源假说的核心机制之一。我们评估是否产前暴露于betterfly预防新生儿呼吸窘迫综合征影响心血管危险因素在30 years of age.Methods我们随访了30岁534个人的母亲参加了一个双盲，安慰剂对照，随机试验的产前betterfly预防新生儿呼吸窘迫综合征。母亲接受两个剂量的倍他米松或安慰剂肌肉注射，间隔24小时。后续评估包括人体测量;测量血压，血脂（空腹过夜后），和清晨皮质醇水平;和75克口服葡萄糖耐量test.Findings-有那些暴露于betlets和安慰剂之间没有差异的身体大小，血脂，血压，血浆皮质醇，糖尿病的患病率，或心血管疾病史。在75 g口服葡萄糖耐量试验后，暴露于beta2的参与者在30分钟时的血浆胰岛素浓度较高（60.5 vs 52.0 mIU/L;几何均值比1.16 [95% CI 1.03 - 1.31]，p=0.02）和120 min时的较低葡萄糖浓度（4.8 vs 5.1 mmol/L;差异-0.26 mmol/L [-0.53至0.001，p=0.05）。解释出生时暴露于better 3可能导致成年后代的胰岛素抵抗，但对30岁时的心血管危险因素没有临床影响。因此，产科医生应继续使用一个单一的课程，产前betchants预防新生儿呼吸窘迫综合征。
Background Antenatal betamethasone treatment is widely used for the prevention of neonatal respiratory distress syndrome in preterm infants and substantially reduces neonatal mortality and morbidity. Fetal exposure to excess glucocorticoids has been proposed as one of the core mechanisms of the fetal origins of adult disease hypothesis. We assessed whether antenatal exposure to betamethasone for the prevention of neonatal respiratory distress syndrome affects cardiovascular risk factors at 30 years of age.Methods We followed up at age 30 years 534 individuals whose mothers participated in a double-blind, placebo-controlled, randomised trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. Mothers received two doses of betamethasone or placebo given by intramuscular injection 24 h apart. Follow-up assessments included anthropometry; measurement of blood pressure, blood lipids (after overnight fasting), and early morning cortisol levels; and a 75 g oral glucose tolerance test.Findings There were no differences between those exposed to betamethasone and to placebo in body size, blood lipids, blood pressure, plasma cortisol, prevalence of diabetes, or history of cardiovascular disease. After a 75 g oral glucose tolerance test, participants exposed to betamethasone had higher plasma insulin concentrations at 30 min (60.5 vs 52.0 mIU/L; ratio of geometric means 1.16 [95% CI 1.03 to 1.31], p=0.02) and lower glucose concentrations at 120 min (4.8 vs 5.1 mmol/L; difference -0.26 mmol/L [-0.53 to 0.001, p=0.05) than did those exposed to placebo.Interpretation Antenatal exposure to betamethasone might result in insulin resistance in adult offspring, but has no clinical effect on cardiovascular risk factors at 30 years of age. Thus, obstetricians should continue to use a single course of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome.