Repeat antenatal steroid exposure and later blood pressure, arterial stiffness, and metabolic profile

Abstract

Objective: To determine the relationship between repeat courses of antenatal corticosteroids (ACS) and risk factors for cardiovascular disease in adolescents and young adults.

Study design: We assessed body mass index, blood pressure, arterial stiffness, blood lipids, and insulin resistance (IR) in a Swedish population-based cohort (n = 100) at a median age of 18 (range 14-26) years. Fifty-eight subjects (36 males) had been exposed to 2-9 weekly courses of antenatal betamethasone and 42 (23 males) were unexposed subjects matched for age, sex, and gestational age (GA).

Results: There were no significant differences between the groups regarding body mass index, systolic or diastolic blood pressures, arterial stiffness measured by augmentation index, blood lipids, IR, or morning cortisol levels either in simple regression or in multivariable models. However, more subjects with elevated augmentation index had been exposed to repeat courses of ACS (n = 7) compared with unexposed subjects (n =1, P = .06), and glucose, insulin, and IR correlated inversely to GA at start of ACS (P < .01).

Conclusions: Repeat courses of ACS did not correlate to adverse cardiovascular risk profile in adolescence and young adulthood, but long-standing effects on the arterial tree and glucose metabolism, the latter dependent on GA at ACS exposure, cannot be excluded. These observations have clinical implications for the ongoing discussion on short-term benefits and long-term safety of repeat ACS treatment.

Keywords: ACS; AI; Antenatal corticosteroid; Apo A1; Apo B; Apolipoprotein A1; Apolipoprotein B; Augmentation index; BMI; BP; Blood pressure; Body mass index; DBP; Diastolic BP; GA; Gestational age; HDL; HOMA; High-density lipoprotein; Homeostatic model assessment; IR; Insulin resistance; LDL; Low-density lipoprotein; SBP; Systolic BP.