Home Medicine Avoiding the prenatal programming effects of glucocorticoids: are there alternative treatments for the induction of antenatal lung maturation?
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Avoiding the prenatal programming effects of glucocorticoids: are there alternative treatments for the induction of antenatal lung maturation?

  • Georgia Justus , Deborah Magdalena Sloboda , Wolfgang Henrich , Andreas Plagemann , Joachim Wolfram Dudenhausen and Thorsten Braun EMAIL logo
Published/Copyright: November 8, 2014

Abstract

Background: The long-term outcomes of antenatal glucocorticoids (GCs) vary between reports, and have generated controversy in terms of repeated and single-course events, causing irreversible effects on endocrine set points.

Aim: This study aimed to assess the effects of alternative therapeutic agents other than synthetic glucocorticoid GC administration for fetal lung maturation.

Methods: A review of literature from PubMed, EMBASE, Cochrane Library, and Google Scholar was conducted to assess the use of alternative therapies to synthetic GCs using recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). End points included the rates of respiratory distress syndrome (RDS), mRNA expression for pneumocyte type II, concentration of surfactant proteins in alveolar lavage, morphological differences, histological proof of lung maturation, and angiogenesis or quantification of the surfactant pool.

Results: In all 41 studies examined, we found that ambroxol showed positive effects on lung maturation, but it has yet to be analyzed with sufficient significance in humans. Interleukins and TNF-alpha produce accelerated lung maturation, but have only been evaluated in basic research/experimental studies. Growth factors promote structural and functional growth in all phases of lung maturation, but little is known about their reciprocal effects and exact mechanisms as therapeutics. Thyroid releasing hormone or vitamin A cause detrimental side effects or were less effective for lung maturation.

Conclusions: The efficacy and safety of these alternative agents are differentiated and none up to now can be recommended as an alternative to GCs.


Corresponding author: Dr. Thorsten Braun, Charité-Universitätsmedizin Berlin, Department of Obstetrics, Charité Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany, Tel.: +49-30450664309, Fax: +49-30450564901, E-mail:
aGeorgia Justus and Deborah Magdalena Sloboda share first authorship on this article.

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-9-4
Accepted: 2014-10-6
Published Online: 2014-11-8
Published in Print: 2015-9-1

©2015 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Risk factors for preterm birth and new approaches to its early diagnosis
  4. Review
  5. Avoiding the prenatal programming effects of glucocorticoids: are there alternative treatments for the induction of antenatal lung maturation?
  6. Original articles – Obstetrics
  7. The association of first trimester bleeding with preterm delivery
  8. Cervical sonoelastography for improving prediction of preterm birth compared with cervical length measurement and fetal fibronectin test
  9. The neuroprotective effect of magnesium sulfate in preterm fetal mice
  10. Correlation of cervical length, fetal fibronectin, phIGFBP-1, and cytokines in spontaneous preterm birth up to 14 days from sampling
  11. The unborn smoker: association between smoking during pregnancy and adverse perinatal outcomes
  12. Association of group B streptococcus colonization with early term births
  13. Association of maternal whole blood fatty acid status during the prenatal period with term birth dimensions: a cross-sectional study
  14. Predicting onset of labor from echogenicity of the cervical gland area on vaginal ultrasonography at term
  15. Disparity in post-treatment maternal circulating magnesium sulfate levels between twin and singleton gestation: Is this the missing link between plurality and adverse outcome?
  16. Original articles – Fetus
  17. Cardiovascular profile score in 44 fetuses with cervicofacial tumors
  18. First trimester tricuspid regurgitation and fetal abnormalities
  19. Gastroschisis: incidence and prediction of growth restriction
  20. Original articles – Newborn
  21. Diminished HLA-DR expression on monocyte and dendritic cell subsets indicating impairment of cellular immunity in pre-term neonates: a prospective observational analysis
  22. First- and fifth-minute Apgar scores of 0–3 and infant mortality: a population-based study in São Paulo State of Brazil
  23. Feeding the feeble: steps towards nourishing preterm infants
  24. Book review
  25. Hot topics in perinatal medicine
  26. Erratum
  27. Erratum to: Impact of the nitric oxide-donor pentaerythrityl-tetranitrate on perinatal outcome in risk pregnancies: a prospective, randomized, double-blinded trial
  28. Congress Calendar
  29. Congress Calendar
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