Search

Collected poems from the 2020 Covid year and beyond by Majura Cafe Poets

Background: Administration of repeat doses of antenatal betamethasone to women at risk of preterm birth 7 or more days after an initial course of glucocorticoids reduces the incidence of respiratory distress syndrome and combined serious morbidity, and has not been associated with any major adverse effects in early childhood. However, exposure to antenatal glucocorticoids could programme physiological changes that increase the risk of adult cardiovascular and metabolic disease. Objective: To assess physiological risk factors for cardiovascular and metabolic disease in New Zealand children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids (ACTORDS). Methods: This study was performed as part of a wider follow-up of neurological and health outcomes in the whole ACTORDS cohort. Follow-up assessments at 6 to 8 years' corrected age included anthropometry, total body DEXA, frequently sampled intravenous glucose tolerance testing with minimal model analysis, 24-hour ambulatory blood pressure monitoring, renal function, and basal and stimulated cortisol concentrations. Results: A total of 301 New Zealand children (92% of survivors) underwent anthropometric assessment, and 264 (88% of those eligible) completed at least one physiological investigation. There were no significant differences between children exposed to repeat doses of antenatal betamethasone and those exposed to a single course of antenatal glucocorticoids (placebo group) in growth, body size, body composition, minimal model indicators of glucose and insulin metabolism, ambulatory blood pressure, renal function, and basal diurnal salivary cortisol concentrations. Children exposed to repeat antenatal betamethasone had slightly reduced plasma cortisol responses to insulin-induced mild hypoglycaemia. In non-randomised analyses, reduced birthweight for gestational age was associated with decreased lean mass in childhood, but gestation length was not significantly associated with physiological outcomes. Conclusions: Exposure to repeat doses of antenatal betamethasone does not alter physiological risk factors for cardiovascular and metabolic disease. Clinicians should consider using repeat doses of betamethasone in women at risk of very preterm birth, 7 or more days after an initial course of glucocorticoids because of the short-term neonatal benefits, which are likely to outweigh any potential long-term harm.