Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses

TRUFFLE Grp; TRUFFLE Grp Authors; TRUFFLE Grp Collaborating Authors; Nicola Fratelli; Federico Prefumo; Hans Wolf; Kurt Hecher; Gerard H. A. Visser; Dino Giussani; Jan B. Derks; Caroline J. Shaw; Tiziana Frusca; Tullio Ghi; E. Ferrazzi; Christoph C. Lees

doi:10.1055/a-0972-1098

Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses

TRUFFLE Grp, TRUFFLE Grp Authors, TRUFFLE Grp Collaborating Authors, Nicola Fratelli, Federico Prefumo^*, Hans Wolf, Kurt Hecher, Gerard H. A. Visser, Dino Giussani, Jan B. Derks, Caroline J. Shaw, Tiziana Frusca, Tullio Ghi, E. Ferrazzi, Christoph C. Lees

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Purpose To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses.

Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (base-line value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV.

Results We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001).

Conclusion Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.

Original language	English
Pages (from-to)	56-64
Number of pages	9
Journal	Ultraschall in der Medizin
Volume	42
Issue number	01
DOIs	https://doi.org/10.1055/a-0972-1098
Publication status	Published - Feb-2021

Keywords

fetal growth restriction
betamethasone
obstetrics

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TRUFFLE Grp, TRUFFLE Grp Authors, TRUFFLE Grp Collaborating Authors, Fratelli, N., Prefumo, F., Wolf, H., Hecher, K., Visser, G. H. A., Giussani, D., Derks, J. B., Shaw, C. J., Frusca, T., Ghi, T., Ferrazzi, E., & Lees, C. C. (2021). Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses. Ultraschall in der Medizin , 42(01), 56-64. https://doi.org/10.1055/a-0972-1098

@article{0ef8398325ff4f1e84c08c33f93b3aaa,

title = "Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses",

abstract = "Purpose To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses.Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (base-line value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV.Results We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001).Conclusion Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.",

keywords = "fetal growth restriction, betamethasone, obstetrics",

author = "{TRUFFLE Grp} and {TRUFFLE Grp Authors} and {TRUFFLE Grp Collaborating Authors} and Nicola Fratelli and Federico Prefumo and Hans Wolf and Kurt Hecher and Visser, {Gerard H. A.} and Dino Giussani and Derks, {Jan B.} and Shaw, {Caroline J.} and Tiziana Frusca and Tullio Ghi and E. Ferrazzi and Lees, {Christoph C.} and B. Arabin and Bilardo, {C. M.} and C. Brezinka and A. Diemert and Duvekot, {J. J.} and W. Ganzevoort and N. Marlow and P. Martinelli and E. Ostermayer and Papageorghiou, {A. T.} and D. Schlembach and Schneider, {K. T. M.} and B. Thilaganathan and J. Thornton and T. Todros and A. Valcamonico and {van Wassenaer-Leemhuis}, A. and A. Aktas and S. Borgione and R. Chaoui and Cornette, {J. M. J.} and T. Diehl and {van Eyck}, J. and {van Haastert}, {I. C.} and S. Lobmaier and E. Lopriore and H. Missfelder-Lobos and G. Mansi and P. Martelli and G. Maso and U. Maurer-Fellbaum and {van Charante}, {N. Mensing} and Tollenaer, {S. Mulderde} and R. Napolitano and M. Oberto and D. Oepkes and G. Ogge and {van der Post}, {J. A. M.}",

year = "2021",

month = feb,

doi = "10.1055/a-0972-1098",

language = "English",

volume = "42",

pages = "56--64",

journal = "Ultraschall in der Medizin ",

issn = "0172-4614",

publisher = "GEORG THIEME VERLAG KG",

number = "01",

}

TRUFFLE Grp, TRUFFLE Grp Authors, TRUFFLE Grp Collaborating Authors, Fratelli, N, Prefumo, F, Wolf, H, Hecher, K, Visser, GHA, Giussani, D, Derks, JB, Shaw, CJ, Frusca, T, Ghi, T, Ferrazzi, E & Lees, CC 2021, 'Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses', Ultraschall in der Medizin , vol. 42, no. 01, pp. 56-64. https://doi.org/10.1055/a-0972-1098

TY - JOUR

T1 - Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses

AU - TRUFFLE Grp

AU - TRUFFLE Grp Authors

AU - TRUFFLE Grp Collaborating Authors

AU - Fratelli, Nicola

AU - Prefumo, Federico

AU - Wolf, Hans

AU - Hecher, Kurt

AU - Visser, Gerard H. A.

AU - Giussani, Dino

AU - Derks, Jan B.

AU - Shaw, Caroline J.

AU - Frusca, Tiziana

AU - Ghi, Tullio

AU - Ferrazzi, E.

AU - Lees, Christoph C.

AU - Arabin, B.

AU - Bilardo, C. M.

AU - Brezinka, C.

AU - Diemert, A.

AU - Duvekot, J. J.

AU - Ganzevoort, W.

AU - Marlow, N.

AU - Martinelli, P.

AU - Ostermayer, E.

AU - Papageorghiou, A. T.

AU - Schlembach, D.

AU - Schneider, K. T. M.

AU - Thilaganathan, B.

AU - Thornton, J.

AU - Todros, T.

AU - Valcamonico, A.

AU - van Wassenaer-Leemhuis, A.

AU - Aktas, A.

AU - Borgione, S.

AU - Chaoui, R.

AU - Cornette, J. M. J.

AU - Diehl, T.

AU - van Eyck, J.

AU - van Haastert, I. C.

AU - Lobmaier, S.

AU - Lopriore, E.

AU - Missfelder-Lobos, H.

AU - Mansi, G.

AU - Martelli, P.

AU - Maso, G.

AU - Maurer-Fellbaum, U.

AU - van Charante, N. Mensing

AU - Tollenaer, S. Mulderde

AU - Napolitano, R.

AU - Oberto, M.

AU - Oepkes, D.

AU - Ogge, G.

AU - van der Post, J. A. M.

PY - 2021/2

Y1 - 2021/2

N2 - Purpose To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses.Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (base-line value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV.Results We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001).Conclusion Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.

AB - Purpose To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses.Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (base-line value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV.Results We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001).Conclusion Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.

KW - fetal growth restriction

KW - betamethasone

KW - obstetrics

U2 - 10.1055/a-0972-1098

DO - 10.1055/a-0972-1098

M3 - Article

SN - 0172-4614

VL - 42

SP - 56

EP - 64

JO - Ultraschall in der Medizin

JF - Ultraschall in der Medizin

IS - 01

ER -