Esteroides prenatales: ¿hora de redefinirlos?

Autores/as

  • Juan Carlos Sabogal

DOI:

https://doi.org/10.18597/rcog.712

Palabras clave:

Dexametasona, betametasona, esteroides prenatales, maduración pulmonar fetal

Resumen

La administración de Esteroides Prenatales (EP) con el fin de inducir la maduración pulmonar fetal ha sido una práctica aceptada durante los últimos 20 años, constituyéndose en una de las medidas prenatales más exitosas en términos de reducción de morbilidad y mortalidad perinatal secundaria a Síndrome de Dificultad Respiratoria Neonatal (SDRN). Reciente evidencia, asocia la administración de tales compuestos a diferentes efectos tanto fetales como maternos que suponen riesgos hasta el momento ignorados. Se revisa la literatura publicada en los últimos 6 años en lo referente a aspectos de dosificación, condiciones clínicas específicas (Ruptura prematura de membranas, recién nacido de muy bajo peso), así como las relaciones existentes entre los EP y ciertos desenlaces perinatales (hemorragia subaracnoidea, leucomalacia periventricular). Se concluye que es necesario redefinir sus indicaciones e individualizar su manejo en entornos clínicos específicos, mientras ensayos clínicos controlados que se llevan a cabo en este momento, permiten juicios sólidos.

Biografía del autor/a

Juan Carlos Sabogal

Profesor Asistente, Facultad de Medicina, Departamento de Ginecobstetricia Universidad Nacional de Colombia. Instituto Materno Infantil. Unidad de Biología Reproductiva, Bogotá.

Referencias bibliográficas

Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50: 515-25.

National Institutes of Health. Report of the consensus development conference on the effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Publication N° 95-3784. November 1994.

National Institute of Health. Antenatal corticosteroids revisited: Repeat courses. NIH Consens Statement Online: www.nih.gov 2000 August 17-18; 17: 1-10.

Canterino JC, Verma U, Visintainer PF, Elimian A, et al. Antenatal steroids and neonatal periventricular leukomalacia. Obstet Gynecol 2001; 97: 135-9.

Baud O, Foix-L'Helias L, Kaminski M, Audibert F, et al. Antenatal glucocorticoid treatment and cystic periventricular leokomalacia in very premature infants. N Engl J Med 1999; 341: 1190-6.

Leviton A, Dammann O, Allred EN, Kuban K, et al. Antenatal corticosteroids and cranial ultrasonographic abnormalities. Am J Obstet Gynecol 1999; 181: 1007-17.

Helal KJ, Gordon MC, Lightner CR, Barth WH. Adrenal suppression induced by betamethasone in women at risk for premature delivery. Obstet Gynecol 2000; 96: 287-90.

Mckenna DS, Wittber GM, Nagaraha HN, Samuels P. The effect of repeat doses of antenatal corticosteroids on maternal adrenal function. Am J Obstet Gynecol 2000; 183: 669-73.

Jeffray TM, Marinoni E, Ramírez MM, Bocking AD, et al. Effect of prenatal betamethasone administration on maternal and fetal corticosteroid-binding globulin concentrations. Am J Obstet Gynecol 1999: 181: 1546-51.

Terrone DA, Rinehart BK, Rhodes PG, Roberts WF, et al. Multiple courses of betamethasone to enhance fetal lung maturation do not suppress neonatal adrenal response. Am J Obstet Gynecol 1999; 180: 1349-53.

Higgins RD, Mendelsohn AL, DeFeo MJ, Ucsel R, Hendricks-Munoz KD Antenatal dexamethasone and decreased severity of retinopathy of prematurity. Arch Ophthalmol 1998 May; 116(5): 601-5

McEvoy C, Bowling S, Williamson K, Collins J, et al. Timing of antenatal corticosteroids and neonatal pulmonary mechanics. Am J Obstet Gynecol 2000; 183: 895-9.

Vermillon ST, Soper DE, Newman RV. Is betamethasone effective longer than 7 days after treatment?. Obstet Gynecol 2001; 97: 491-3.

Bloom SL, Sheffield JS, McIntire DD, Leveno KJ. Antenatal dexamethasone and decreased birth weight. Obstet Gynecol 2001; 97: 485-90.

Ballard PL, Ballard RA. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. Am J Obstet Gynecol 1995; 173: 254-262.

Chapman SJ, Hauth JC, Bottoms SF, Iams JD, et al. Benefits of maternal corticosteroid therapy in infants weighing £ 1000 grams at birth after preterm rupture of the amnion. Am J Obstet Gynecol 1999; 180: 677-82.

Vermillion ST, Soper DE, Chasedunn-Roark J. Neonatal sepsis after betamethasone administration to patients with preterm premature of membranes. Am J Obstet Gynecol 1999; 181: 320-7.

The Dexiprom Study Group. The use of dexamethasone in women with preterm premature rupture of membranes. A multicentre, double blind, placebo-controlled, randomized trial. S Afr Med J 1999; 89: 865-870.

Vermillon ST, Soper DE, Bland ML, Newman RB. Effectiveness of antenatal corticosteroid administration after preterm premature rupture of the membranes. Am J Obstet Gynecol. 2000; 183: 925-9.

Vermillion ST, Soper DE, Newman RB. Neonatal sepsis and death after multiple courses of antenatal betamethasone therapy. Am J Obstet Gynecol 2000; 183: 810-4.

Stewart JD, González CL, Christensen HD, Rayburn WF. Impact of multiple antenatal doses of betamethasone on growth and development of mice offspring. Am J Obstet Gynecol 1997; 177: 1138-44.

Jobe AH, Wada N, Berry LM, Ikegami M, Ervin MG. Single and repetitive maternal glucocorticoid exposures reduce fetal growth in sheep. Am J Obstet Gynecol 1988; 178: 880-5.

Abbassi S, Hirsch D, Davis J, Tolosa J, et al. Effect of single versus multiple courses of corticosteroids on maternal and neonatal outcome. Am J Obstet Gynecol 2000; 182: 1243-9.

French NP, Hagan R, Evans SF, Godfrey M, Newnham JP. Repeated antenatal corticosteroids: size at birth and subsequent development. Am J Obstet Gynecol 1999; 180: 114-21.

Elimian A, Verma U, Visintainer P, Tejani N. Effectiveness of multidose antenatal steroids. Obstet Gynecol 2000; 95:34-6.

Shelton SD, Boggess KA, Murtha AP, Groff AO, Herbert WNP. Repeated fetal betamethasone treatment and birth weight and head circumference. Obstet Gynecol 2001; 97: 301-4.

Stewart JD, Sienko AE, González CL, Christensen HD, Rayburn WF. Placebo-controlled comparison between a single dose and multidose of betamethasone in accelerating lung maturation of mice offspring. Am J Obstet Gynecol 1998; 179: 1241-7.

Banks BA, Cnaan A, Morgan MA, Parer JT, et al. Multiple courses of antenatal corticosteroids and outcome of premature neonates. Am J Obstet Gynecol 1999; 181: 709-17.

Uno H, Eisele S, Sakai A, et al. Neurotoxicity of glucocorticoids in the primate brain. Horm Behav 1994; 28: 336-48.

Levitt NS, Lindsay RS, Holmes RC, Seckl JR. Dexamethasone in the last week of pregnancy attenuates hippocampal glucocorticoid receptor gene expression and elevates blood pressure in the adult offspring in the rat. Neuroendocrinology 1996; 64: 412-18.

Rotmensch S, Liberati M, Vishne TH, Celentano C, Ben-Rafael Z, Bellati U. The effect of betamethasone and dexamethasone on fetal heart rate patterns and biophysical activities. A prospective randomized trial. Acta Obstet Gynecol Scand 1999 Jul; 78(6): 493-500.

Mulder EJ, Derks JB, Visser GH. Antenatal corticosteroid therapy and fetal behaviour: a randomized study of the effects of betamethasone and dexamethasone. Br J Obstet Gynecol 1997 Nov; 104(11): 1239-47.

Rotmensch S, Celentano C, Liberati M, Sadan O, Glezerman M. The effect of antenatal steroid administration on the fetal response to vibroacoustic stimulation. Acta Obstet Gynecol Scand 1999 Nov; 78(10): 847-51.

Kelly MK, Schneider EP, Petrikovsky BM, Lesser ML. Effect of antenatal steroid administration on the fetal biophysical profile. J Clin Ultrasound 2000 Jun; 28(5): 224-6.

Rotmensch S, Liberati M, Celentano C, Efrat Z, Bar-Hava I, Kovo M, Golan A, Moravski G, Ben-Rafael Z. The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries. Acta Obstet Gynecol Scand 1999 Oct; 78(9): 768-73.

Piazze JJ, Anceschi MM, La Torre R, Amici F, Maranghi L, Cosmi EV. Effect of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry. Early Hum Dev 2001 Jan; 60(3): 225-32.

Wallace EM, Baker LS. Effect of antenatal betamethasone administration on placental vascular resistance. Lancet 1999; 353: 1404-7.

Turrentine MA, Wilson PD, Wilkins IA. A retrospective analysis of the effect of antenatal steroid administration on the incidence of respiratory distress syndrome in preterm twin pregnancies. Am J Perinatol 1996 Aug; 13(6): 351-4.

Quist-Therson EC, Myhr TL, Ohlsson A. Antenatal steroids to prevent respiratory distress syndrome: multiple gestation as an effect modifier. Acta Obstet Gynecol Scand 1999 May; 78(5): 388-92.

Cómo citar

1.
Sabogal JC. Esteroides prenatales: ¿hora de redefinirlos?. Rev. colomb. obstet. ginecol. [Internet]. 28 de septiembre de 2001 [citado 28 de marzo de 2024];52(3):235-41. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/712

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2001-09-28

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