scholarly journals Antenatal Corticosteroids: A Risk Factor for the Development of Chronic Disease

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth Asztalos
Keyword(s):  
Preterm Birth ◽  
Hpa Axis ◽  
Animal Studies ◽  
Fetal Lung ◽  
Later Life ◽  
Long Term Effects ◽  
Antenatal Corticosteroids ◽  
Fetal Maturity ◽  
Hpa Axis Activity

Preterm birth remains a major health issue worldwide. Since the 1990s, women at risk for preterm birth received a single course of exogenous antenatal corticosteroids (ACSs) to facilitate fetal lung maturity. More recently, repeated or multiple courses of ACS have been supported to provide continued fetal maturity support for women with continued risk of preterm birth. However, exogenous ACS reduces birth weight which, in turn, is associated with adverse adult outcomes such as coronary heart disease, stroke, hypertension, and type 2 diabetes. The long-term effects of ACS exposure on HPA axis activity and neurological function are well documented in animal studies, and it appears that ACS, regardless of dose exposure, is capable of affecting fetal HPA axis development causing permanent changes in the HPA axis that persists through life and is manifested by chronic illness and behavioral changes. The challenge in human studies is to demonstrate whether an intervention such as ACS administration in pregnancy contributes to developmental programming and how this is manifested in later life.

Long-term effects of prenatal stress on HPA axis activity in juvenile rhesus monkeys

1994 ◽  
Vol 27 (5) ◽  
pp. 257-269 ◽  
Author(s):  
A. S. Clarke ◽  
D. J. Wittwer ◽  
D. H. Abbott ◽  
M. L. Schneider
Keyword(s):  
Hpa Axis ◽  
Prenatal Stress ◽  
Rhesus Monkeys ◽  
Long Term Effects ◽  
Hpa Axis Activity

scholarly journals Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing?

2019 ◽  
Vol 25 (5) ◽  
pp. 593-600 ◽  
Author(s):  
Lenka Hrabalkova ◽  
Tsukasa Takahashi ◽  
Matthew W. Kemp ◽  
Sarah J. Stock
Keyword(s):  
Preterm Birth ◽  
Fetal Lung ◽  
Corticosteroid Treatment ◽  
Antenatal Corticosteroid ◽  
Clinical Practices ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Corticosteroid Administration ◽  
Fetal Organ

Background: Between 5-15% of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood. Aims: This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticosteroids and the evidence of potential harm to offspring are also summarised. Results: Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recommended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal. Conclusion: Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.

scholarly journals Long-Term Effects of Abuse in Later Life Perpetrated by Family Members

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 444-445
Author(s):  
Naomi Meinertz ◽  
Pi-Ju Liu ◽  
Ron Acierno
Keyword(s):  
Social Support ◽  
Depressive Symptoms ◽  
Family Member ◽  
Older Adult ◽  
Family Members ◽  
Later Life ◽  
Adult Health ◽  
Long Term Effects ◽  
Long Term Impact

Abstract Abuse in later life could potentially lead to lower levels of social support, especially when perpetrated by family members who are charged with protecting the older adult in their care. Using both waves of the National Elder Mistreatment longitudinal data (wave one collected in 2008 and wave two in 2015; N=774), long-term effects of abuse (i.e., physical, emotional, sexual, and financial) on levels of social support, physical health, and clinical depressive symptoms for respondents at or above the age of 60 years were analyzed. A multivariate analysis of variance showed that respondents abused at wave one (n=261) by a family member (B=-0.55, p≤0.001), a spouse or ex-partner (B=-0.349, p=0.02), or a non-relative or stranger (B=-0.301, p=0.026) had lower levels of social support eight years later at wave two. Those abused by a family member at wave one also experienced higher levels of depressive symptoms at wave two (B=-0.187, p=0.01). Perpetrator type did not predict general health at wave two. These results emphasize the long-term impact of abuse on the lives of older adults and highlight the importance trusted relationships, such as with family members, have on older adult health and wellbeing.

scholarly journals Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 593
Author(s):  
Sumesh Thomas ◽  
Elizabeth Asztalos
Keyword(s):  
Decision Making ◽  
Preterm Birth ◽  
Current Knowledge ◽  
First Trimester ◽  
Perinatal Period ◽  
Outcome Data ◽  
Future Research ◽  
Extremely Preterm ◽  
Fetal Maturity

Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3–7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider’s decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority—identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability.

scholarly journals Language in Preterm Born Children: Atypical Development and Effects of Early Interventions on Neuroplasticity

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Charlotte Vandormael ◽  
Lucie Schoenhals ◽  
Petra S. Hüppi ◽  
Manuela Filippa ◽  
Cristina Borradori Tolsa
Keyword(s):  
Preterm Birth ◽  
Language Development ◽  
Early Exposure ◽  
Long Term Effects ◽  
School Aged Children ◽  
Short And Long Term ◽  
Atypical Development ◽  
Preterm Born ◽  
And Behavior

Predicting language performances after preterm birth is challenging. It is described in the literature that early exposure to the extrauterine environment can be either detrimental or advantageous for neurodevelopment. However, the emphasis mostly lies on the fact that preterm birth may have an unfavorable effect on numerous aspects of development such as cognition, language, and behavior. Various studies reported atypical language development in preterm born children in the preschool years but also in school-aged children and adolescents. This review gives an overview of the course of language development and examines how prematurity can lead to atypical linguistic performances. In this paper, we mainly focus on environmental and neurophysiological factors influencing preterm infant neuroplasticity with potential short- and long-term effects on language development. Further research, however, should focus on examining the possible benefits that early exposure might entail.

scholarly journals Severe but not moderate hyperoxia of newborn mice causes an emphysematous lung phenotype in adulthood without persisting oxidative stress and inflammation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anke Kindermann ◽  
Leonore Binder ◽  
Jan Baier ◽  
Beate Gündel ◽  
Andreas Simm ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Later Life ◽  
Lung Compliance ◽  
Elastic Fibers ◽  
Newborn Mouse ◽  
Long Term Effects ◽  
Newborn Mice ◽  
Functional Changes ◽  
Oxygen Concentrations

Abstract Background Preterm newborns typically require supplemental oxygen but hyperoxic conditions also damage the premature lung. Oxygen-induced lung damages are mainly studied in newborn mouse models using oxygen concentrations above 75% and looking at short-term effects. Therefore, we aimed at the investigation of long-term effects and their dependency on different oxygen concentrations. Methods Newborn mice were exposed to moderate vs. severe hyperoxic air conditions (50 vs. 75% O2) for 14 days followed by a longer period of normoxic conditions. Lung-related parameters were collected at an age of 60 or 120 days. Results Severe hyperoxia caused lower alveolar density, enlargement of parenchymal air spaces and fragmented elastic fibers as well as higher lung compliance with peak airflow limitations and higher sensitivity to ventilation-mediated damages in later life. However, these long-term lung structural and functional changes did not restrict the voluntary physical activity. Also, they were not accompanied by ongoing inflammatory processes, increased formation of reactive oxygen species (ROS) or altered expressions of antioxidant enzymes (superoxide dismutases, catalase) and lung elasticity-relevant proteins (elastin, pro-surfactant proteins) in adulthood. In contrast to severe hyperoxia, moderate hyperoxia was less lung damaging but also not free of long-term effects (higher lung compliance without peak airflow limitations, increased ROS formation). Conclusions Severe but not moderate neonatal hyperoxia causes emphysematous lungs without persisting oxidative stress and inflammation in adulthood. As the existing fragmentation of the elastic fibers seems to play a pivotal role, it indicates the usefulness of elastin-protecting compounds in the reduction of long-term oxygen-related lung damages.

scholarly journals 531: Long-term effects of cervical pessary for preterm birth prevention in twin pregnancy with short cervix: a 3 years follow-up of the ProTwin trial

2016 ◽  
Vol 214 (1) ◽  
pp. S287 ◽  
Author(s):  
Janneke van 't Hooft ◽  
Cuny Cuijpers ◽  
Johanna H. van der Lee ◽  
Sophie Liem ◽  
Ewoud Schuit ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Twin Pregnancy ◽  
Long Term Effects ◽  
Short Cervix ◽  
Cervical Pessary
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