Betamethasone in pregnancy: influence of maternal body weight and multiple gestation on pharmacokinetics

Objective The goals of the study were to estimate the pharmacokinetic parameters of standard dose betamethasone in a large obstetrics population and evaluate the effect of maternal body size and multiple gestation on the pharmacokinetic parameters and their observed variability. Study Design This wa...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2010-09, Vol.203 (3), p.254.e1-254.e12
Main Authors: Della Torre, Micaela, MD, MS, Hibbard, Judith U., MD, Jeong, Hyunyoung, PharmD, PhD, Fischer, James H., PharmD
Format: Article
Language:English
Subjects:
Adolescent
Adult
antenatal steroid
Area Under Curve
Bayes Theorem
betamethasone
Betamethasone - blood
Betamethasone - pharmacokinetics
Biological and medical sciences
Body Mass Index
Body Weight
Bones, joints and connective tissue. Antiinflammatory agents
Chromatography, Liquid
Female
Glucocorticoids - blood
Glucocorticoids - pharmacokinetics
Gynecology. Andrology. Obstetrics
Humans
Medical sciences
Middle Aged
Obstetrics and Gynecology
pharmacokinetics
Pharmacology. Drug treatments
Pregnancy
Pregnancy, Multiple
prematurity
Prospective Studies
Tandem Mass Spectrometry
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Summary:Objective The goals of the study were to estimate the pharmacokinetic parameters of standard dose betamethasone in a large obstetrics population and evaluate the effect of maternal body size and multiple gestation on the pharmacokinetic parameters and their observed variability. Study Design This was a prospective pharmacokinetic study. Liquid chromatography mass spectrometry was used to measure betamethasone plasma concentrations. Pharmacokinetic parameters and significant clinical covariates were estimated with mixed effect modeling. Bootstrap analysis confirmed validity of the model. Results Two hundred seventy-four blood samples from 77 patients were obtained. The greatest effect on pharmacokinetic variability was observed with maternal lean body weight (LBW). The relationship between the pharmacokinetic parameters and LBW remained linear over a wide range of maternal body sizes. Multiple gestations did not affect the pharmacokinetic parameters. Conclusion Individualization of betamethasone dosing by maternal LBW reduces variability in drug exposure. Mutiple gestations do not require betamethasone dosing adjustment, because pharmacokinetics are the same as singleton gestations.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2010.06.029