Corticoides: El lado oscuro de una buena idea

[Corticoides: El lado oscuro de una buena idea]

O Reyes1

1. Hospital Santo Tomás.

Publicado: 2019-04-10

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Resumen

[Corticoids: the dark side of a good idea]

Resumen
Los corticoides son una de las terapias materno fetales más efectivas de la medicina moderna. Miles de niños en todo el mundo sobreviven cada año gracias a sus efectos, ayudándolos a sobreponerse a las complicaciones propias de la prematuridad, ya sea espontánea o iatrogénica (positiva o negativa). Sin embargo, los corticoides son drogas poderosas con indicaciones muy precisas en la vida extra uterina. Su uso en el embarazo y la capacidad que tienen de afectar de múltiples formas al feto en desarrollo se está empezando a investigar y los resultados nos muestran una realidad que no estábamos percibiendo. La evidencia actual nos debe obligar a pensar en las consecuencias y a realmente evaluar riesgos vs. beneficios antes de ordenar su aplicación rutinaria.

Abstract
Corticosteroids are one of the most effective maternal fetal therapies in modern medicine. Thousands of children around the world survive every year thanks to their effects, helping them to overcome the complications of prematurity, whether spontaneous or iatrogenic (positive or negative). However, corticosteroids are powerful drugs with very precise indications in extra uterine life. Their use in pregnancy and their ability to affect the developing fetus in multiple ways is beginning to be investigated and the results show us a reality that we were not perceiving. The current evidence should force us to think about the consequences and to really evaluate risks vs. benefits before ordering its routine application.


Abstract

[Corticoids: the dark side of a good idea]

Resumen
Los corticoides son una de las terapias materno fetales más efectivas de la medicina moderna. Miles de niños en todo el mundo sobreviven cada año gracias a sus efectos, ayudándolos a sobreponerse a las complicaciones propias de la prematuridad, ya sea espontánea o iatrogénica (positiva o negativa). Sin embargo, los corticoides son drogas poderosas con indicaciones muy precisas en la vida extra uterina. Su uso en el embarazo y la capacidad que tienen de afectar de múltiples formas al feto en desarrollo se está empezando a investigar y los resultados nos muestran una realidad que no estábamos percibiendo. La evidencia actual nos debe obligar a pensar en las consecuencias y a realmente evaluar riesgos vs. beneficios antes de ordenar su aplicación rutinaria.

Abstract
Corticosteroids are one of the most effective maternal fetal therapies in modern medicine. Thousands of children around the world survive every year thanks to their effects, helping them to overcome the complications of prematurity, whether spontaneous or iatrogenic (positive or negative). However, corticosteroids are powerful drugs with very precise indications in extra uterine life. Their use in pregnancy and their ability to affect the developing fetus in multiple ways is beginning to be investigated and the results show us a reality that we were not perceiving. The current evidence should force us to think about the consequences and to really evaluate risks vs. benefits before ordering its routine application.

Biografía del autor/a

O Reyes, Hospital Santo Tomás

Miembro del Sistema Nacional de Investigadores de Panamá. Coordinación de investigaciones de la Maternidad del Hospital Santo Tomás.

Citas

[1] Liggins GC. Premature delivery of foetal lambs infused with glucocorticoids. J Endocrinol. 1969 Dec;45(4):515-23.

[2] Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972 Oct;50(4):515-25.

[3] Crowley P, Chalmers I, Keirse MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol. 1990 Jan;97(1):11-25.

[4] Gilstrap LC, Christensen R, Clewell WH, et al. Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes: NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. JAMA. 1995;273(5):413–418.

[5] Althabe F, Belizán JM, McClure EM, Hemingway-Foday J, Berrueta M, Mazzoni A et al. A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial. Lancet. 2015 Feb 14;385(9968):629-639.

[6] Althabe F, Thorsten V, Klein K, McClure EM; Hibberd PL, Goldenberg RL et al. The Antenatal Corticosteroids Trial (ACT)'s explanations for neonatal mortality - a secondary analysis. Reprod Health. 2016;13(1):62.

[7] Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet. 1986 May 10;1(8489):1077-81.

[8] Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet. 1989;2(8663):577–580.

[9] Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993;341(8850):938–941.

[10] Lewis A.J., Galbally M., Gannon T., Symeonides C. Early life programming as a target for prevention of child and adolescent mental disorders. BMC Med. 2014 Feb 24;12:33: 1-15.

[11] Sandman CA. Fetal exposure to placental corticotropin-releasing hormone (pCRH) programs developmental trajectories. Peptides. 2015;72:145-53.

[12] Salvante KG, Milano K, Kliman HJ, Nepomnaschy PA. Placental 11 β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) expression very early during human pregnancy. J Dev Orig Health Dis. 2017 Apr; 8(2):149-154.

[13] Cottrell EC, Seckl JR, Holmes MC, Wyrwoll CS. Foetal and placental 11β-HSD2: a hub for developmental programming. Acta Physiol (Oxf). 2014 Feb;210(2):288-95.

[14] De Kloet ER, Vreugdenhil E, Oitzl MS, et al. Brain corticosteroid receptor balance in health and disease. Endocr Rev. 1998; 19(3):269–301

[15] Abbasi S, Hirsch D, Davis J, Tolosa J, Stouffer N, et al. (2000) Effect of single versus multiple courses of antenatal corticosteroids on maternal and neonatal outcome. Am J Obstet Gynecol 182: 1243–1249.

[16] Dirnberger DR, Yoder BA, Gordon MC (2001) Single versus repeated-course antenatal corticosteroids: outcomes in singleton and multiple-gestation pregnancies. Am J Perinatol 18: 267–267.

[17] Murphy KE, Hannah ME, Willan AR, Hewson SA, Ohlsson A, Kelly EN. Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial. Lancet. 2008 Dec 20;372(9656):2143-51.

[18] Crowther CA, Haslam RR, Hiller JE, Doyle LW, Robinson JS (2006) Australasian Collaborative Trial of Repeat Doses of Steroids (ACTORDS) Study Group, Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomised controlled trial. Lancet 367: 1913–1919.

[19] Wapner RJ, Sorokin Y, Thom EA, Johnson F, Dudley DJ, et al. (2006) National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network, Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol 195: 633–642.

[20] Tijsseling D, Wijnberger LD, Derks JB, van Velthoven CT, de Vries WB, van Bel F et al. Effects of antenatal glucocorticoid therapy on hippocampal histology of preterm infants. PLoS One. 2012; 7(3):e33369.

[21] Murphy KE, Willan AR, Hannah ME, Ohlsson A, Kelly EN, Matthews SG. Effect of antenatal corticosteroids on fetal growth and gestational age at birth. Obstet Gynecol. 2012 May;119(5):917-23.

[22] Thorp JA, Jones PG, Knox E, Clark RH. Does antenatal corticosteroid therapy affect birth weight and head circumference? Obstet Gynecol. 2002 Jan;99(1):101-8.

[23] Wapner RJ, Sorokin Y, Thom EA, Johnson F, Dudley DJ, Spong CY, et al. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Am J Obstet Gynecol 2006;195:633–42.

[24] 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.

[25] Guinn DA, Atkinson MW, Sullivan L, Lee M, MacGregor S, Parilla BV, et al. Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery: A randomized controlled trial. JAMA 2001;286:1581–7.

[26] Pratt L, Waschbusch L, Ladd W, Gangnon R, Hendricks SK. Multiple vs. single betamethasone therapy. Neonatal and maternal effects. J Reprod Med 1999;44:257–64.

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

[28] Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD004454.

[29] Rodriguez A, Wang Y, Ali Khan A, Cartwright R, Gissler M, Järvelin M-R (2019) Antenatal corticosteroid therapy (ACT) and size at birth: A population-based analysis using the Finnish Medical Birth Register. PLoS Med 16(2): e1002746. https://doi.org/10.1371/journal.pmed.1002746.

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