Controversial issues of antenatal glucocorticoid use in fetal growth retardation

DOI

https://dx.doi.org/10.18565/aig.2023.157

Leonova A.A., Kan N.E., Tyutyunnik V.L., Borisova A.G., Gasymova S.R.
Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

The paper presents the analysis of modern literature data on the effect of glucocorticoids on the fetus with intrauterine growth retardation. The research focuses on mechanisms and scientific hypotheses that describe the effects of glucocorticoids on various organs and tissues of the fetus including the central nervous system with adverse consequences for further postnatal development. The role of 11β-hydroxysteroid dehydrogenase enzymes (11β-HSD1 and 11β-HSD2) is discussed. The studies conducted on both humans and animals have shown that acute and chronic stress can affect the expression of 11ß-HSD2 in the placenta in different ways. The expression of 11ß-HSD2 is stimulated in acute stress reactions, the expression of 11ß-HSD2 in the placenta is inhibited in chronic stress. It is likely that activation of placental 11ß-HSD2 in acute stress can be defined as an immediate protective measure taken by the fetus against a sudden increase in maternal glucocorticoids, while inhibition of placental 11ß-HSD2 in chronic stress may be a strategy adopted by the fetus for its survival. According to recent data, there is a decrease in the activity of 11ß-HSD2 when intrauterine growth is delayed. This decrease causes an elevation in the level of cortisol in the fetal blood which leads to disorders of postnatal development, cardiovascular and neuroendocrine pathology in the postnatal period of life. The use of antenatal glucocorticoids in pregnant women who are at risk of preterm birth and diagnosed with fetal growth retardation remains controversial: excessive exposure to glucocorticoids interferes with the normal development of the fetal nervous system. Conclusion: Due to the high frequency of the use of synthetic glucocorticoids in pregnant women who are at risk of preterm birth, it would be interesting to study the long-term effects of such action on the development of children in various periods of ontogenesis, especially in children with intrauterine growth retardation. Therefore, it is necessary to clarify the cellular and molecular mechanisms that cause placental dysfunction in fetal growth retardation in order to optimize the tactics of management of pregnant women with this pregnancy complication.

Authors’ contributions: Leonova A.A., Kan N.E., Tyutyunnik V.L., Borisova A.G., Gasymova S.R. – developing the concept and design of the study, obtaining the data for analysis, collecting publications, processing and analyzing material on the topic, writing the text of the manuscript, editing the article.

Conflicts of interest: The authors declare no conflicts of interest.

Funding: The study was conducted without sponsorship.

For citation: Leonova A.A., Kan N.E., Tyutyunnik V.L., Borisova A.G., Gasymova S.R. Controversial issues of antenatal glucocorticoid use in fetal growth retardation. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (10): 14-20 (in Russian) https://dx.doi.org/10.18565/aig.2023.157

fetal growth retardation

glucocorticoids

infant respiratory distress syndrome

prevention

metabolic syndrome

11ß-hydroxysteroid dehydrogenase enzymes

Full text (in Russian)

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Received 16.06.2023

Accepted 13.09.2023

Anastasia A. Leonova, postgraduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(937)453-54-27, nastena27-03@mail.ru, https://orcid.org/0000-0001-6707-3464, 117997, Russia, Moscow, Ac. Oparina str., 4.
Natalia E. Kan, Professor, MD, PhD, Deputy Director of Science, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(926)220-86-55, kan-med@mail.ru. Researcher ID: B-2370-2015, SPIN-код: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600, https://orcid.org/0000-0001-5087-5946, 117997, Russia, Moscow, Ac. Oparina str., 4.
Victor L. Tyutyunnik, Professor, MD, PhD, Leading Researcher of the Center for Scientific and Clinical Research, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(903)969-50-41, tioutiounnik@mail.ru. Researcher ID: B-2364-2015, SPIN-код: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099, 117997, Russia, Moscow, Ac. Oparina str., 4.
Anastasia G. Borisova, postgraduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, +7(968)735-40-81, vvv92@list.ru, https://orcid.org/0009-0004-5234-1584, 117997, Russia, Moscow, Ac. Oparina str., 4.
Shagane R. Gasymova, Junior Researcher, Department of Fetal Medicine, Institute of Obstetrics; ultrasound diagnostics doctor, Department of Ultrasound and Functional Diagnostics, obstetrician-gynecologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Health of Russia, +7(916)542-22-99, shagane2501@mail.ru, https://orcid.org/0009-0001-2626-6670, 117997, Russia, Moscow, Ac. Oparina str. 4.

Controversial issues of antenatal glucocorticoid use in fetal growth retardation

Leonova A.A., Kan N.E., Tyutyunnik V.L., Borisova A.G., Gasymova S.R.

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