Multiple courses of betamethasone to enhance fetal lung maturation do not suppress neonatal adrenal response

• Published in: American journal of obstetrics and gynecology 1999-06, Vol.180 (6), p.1349-1353
• Main Authors: Terrone, Dom A., Rinehart, Brian K., Rhodes, Philip G., Roberts, William E., Miller, Richard C., Martin, James N.
• Format: Article
• Language: English
• Subjects: adrenal gland; Adrenal Glands - drug effects; Betamethasone - administration & dosage; Betamethasone - adverse effects; Betamethasone - therapeutic use; Corticosteroids; Cosyntropin; Female; fetal lung maturity; Fetal Organ Maturity - drug effects; Humans; Hydrocortisone - blood; Infant, Newborn; Lung - embryology; Pregnancy; Prenatal Exposure Delayed Effects; respiratory distress syndrome
• ISSN: 0002-9378
• DOI: 10.1016/S0002-9378(99)70018-9

Objective: Our purpose was to evaluate the neonatal adrenal gland by provocative testing in neonates of mothers who had received multiple courses of betamethasone to enhance fetal lung maturity. Study Design: Infants of mothers who had received ≥3 courses of betamethasone for fetal lung maturation were enrolled in the study. Twenty-four hours after delivery a baseline serum cortisol concentration was obtained. A synthetic adrenocorticotropic hormone (Cortrosyn) was administered (0.25 mg/1.73 m 2). Two hours later a second serum cortisol concentration was obtained. An increase in serum cortisol in response to Cortrosyn was considered a positive test result. Nominal data were compared by means of the Student t test. Results: There were 9 infants enrolled in the study. The mean number of betamethasone treatment cycles was 4.8 ± 1.09. The mean baseline cortisol level was 2.23 ± 0.52 μg/dL, and the mean post–adrenocorticotropic hormone cortisol level was 9.86 ± 1.70 μg/dL. All neonates had a positive adrenocorticotropic hormone test result. Stepwise linear regression showed no association between the number of courses of betamethasone treatment cycles and the post–adrenocorticotropic hormone cortisol concentration. Conclusion: Multiple weekly treatment cycles of betamethasone for fetal lung maturity administered between 24 and 34 weeks’ gestation do not appear to cause adrenal suppression. (Am J Obstet Gynecol 1999;180:1349-53.)