Hasan Tolga ÇELİK, Ayşe KORKMAZ, Özgür ÖZYÜNCÜ, Şule YİĞİT, Murat YURDAKÖK

Maternal adipose tissue, antenatal steroids, and Respiratory Distress syndrome: complex relations

The incidences of maternal obesity and obesity-related maternal, fetal andneonatal complications have increased considerably. Obese people may havelower, normal or increased fat mass independent from their body mass index.We aimed to investigate the relationships between antenatal steroid therapyand maternal body fat ratio for the risk of Respiratory distress syndrome(RDS) in preterm infants.Pregnant women and their newborn infants between 24-34 weeks of gestation,who received a full course of antenatal steroid therapy were included in thestudy. Mother’s body weight, body mass ındex (BMI), and body compositions(muscle, fat, water) were calculated using the bioelectrical impedance method5 days after giving birth. Neonatal characteristics and respiratory outcomeswere noted.A total of 42 mothers and their single premature infants were included in thestudy. Nineteen (45.2%) infants developed RDS (Group 1) while 23 (54.8%)infants did not develop RDS (Group 2). The mean body fat mass (kg), fatratio (%), truncal fat mass (kg), and truncal fat ratio (%) were statisticallysignificantly higher in Group 1 than in Group 2. The incidence of RDS wassignificantly higher in the group of mothers with a body fat ratio >30.0%(n=15/24, 62.5%) when compared with the group of mothers with a body fatratio ≤ 30% (n=4/18, 22.2%) (p=0.013).Maternal adipose tissue plays an important role and should be taken intoconsideration especially in obese women, before giving antenatal steroids toachieve positive effects of the therapy in preterm infants.

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1. Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454.

2. Committee on Obstetric Practice. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol 2017; 130: e102-e109.

3. Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2013; 8: CD006764.

4. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002; 288: 1723-1727.

5. Walls HL, Magliano DJ, Stevenson CE, et al. Projected progression of the prevalence of obesity in Australia. Obesity (Silver Spring) 2012; 20: 872-878.

6. Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol 2016; 4: 1025-1036.

7. Kim T, Burn SC, Bangdiwala A, Pace S, Rauk P. Neonatal morbidity and maternal complication rates in women with a delivery body mass index of 60 or higher. Obstet Gynecol 2017; 130: 988-993.

8. Smid MC, Vladutiu CJ, Dotters-Katz SK, Manuck TA, Boggess KA, Stamilio DM. Maternal super obesity and neonatal morbidity after term cesarean delivery. Am J Perinatol 2016; 33: 1198-1204.

9. Zhong Y, Cahill AG, Macones GA, Zhu F, Odibo AO. The association between prepregnancy maternal body mass index and preterm delivery. Am J Perinatol 2010; 27: 293-298.

10. Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab 2002; 87: 4231-4237.

11. McGillick EV, Lock MC, Orgeig S, Morrison JL. Maternal obesity mediated predisposition to respiratory complications at birth and in later life: understanding the implications of the obesogenic intrauterine environment. Paediatr Respir Rev 2017; 21: 11-18.

12. Rowe S, Siegel D, Benjamin DK Jr; Best Pharmaceuticals for Children Act -Pediatric Trials Network Administrative Core Committee. Gaps in Drug Dosing for Obese Children: A Systematic Review of Commonly Prescribed Emergency Care Medications. Clin Ther 2015; 37: 1924-1932.

13. Claire L, Vieux R. Efficacy of antenatal corticosteroids according to maternal and perinatal factors: a retrospective cohort study. Am J Perinatol 2015; 32: 1070-1077.

14. Hashima JN, Lai Y, Wapner RJ, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The effect of maternal body mass index on neonatal outcome in women receiving a single course of antenatal corticosteroids. Am J Obstet Gynecol 2010; 202: 263.e1-263.e5.

15. Thompson PD, Arena R, Riebe D, Pescatello LS; American College of Sports Medicine. ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep 2013; 12: 215-217.

16. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 2000; 72: 694-701.

17. Hamvas A. Pathophysiology and management of respiratory distress syndrome. In: Martin RJ, Fanaroff AA, Walsh MC (eds). Fanaroff and Martin’s NeonatalPerinatal Medicine (9th ed) Vol 1. St. Louis: Elsevier Mosby, 2011: 1106-1116.

18. Nisbet AC. Intramuscular gluteal injections in the increasingly obese population: retrospective study. BMJ 2006; 332: 637-638.

19. Chan CC, Ng EH, Chan MM, et al. Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women. Hum Reprod 2003; 18: 2294-2297.

20. Elkind-Hirsch KE, Bello S, Esparcia L, Phillips K, Sheiko A, McNichol M. Serum human chorionic gonadotropin levels are correlated with body mass index rather than route of administration in women undergoing in vitro fertilization-embryo transfer using human menopausal gonadotropin and intracytoplasmic sperm injection. Fertil Steril 2001; 75: 700-704.

21. Gyamfi C, Mele L, Wapner RJ, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The effect of plurality and obesity on betamethasone concentrations in women at risk for preterm delivery. Am J Obstet Gynecol 2010; 203: 219.e1-5.

22. Barras M, Legg A. Drug dosing in obese adults. Aust Prescr 2017; 40: 189-193.

23. Della Torre M, Hibbard JU, Jeong H, Fischer JH. Betamethasone in pregnancy: influence of maternal body weight and multiple gestation on pharmacokinetics. Am J Obstet Gynecol 2010; 203: 254.e1-12.

24. Li J, Daly E, Campioli E, Wabitsch M, Papadopoulos V. De novo synthesis of steroids and oxysterols in adipocytes. J Biol Chem 2014; 289: 747-764.

25. Chapman K, Holmes M, Seckl J. 11β-hydroxysteroid dehydrogenases: intracellular gate-keepers of tissue glucocorticoid action. Physiol Rev 2013; 93: 1139- 1206.

26. Morton NM. Obesity and corticosteroids: 11betahydroxysteroid type 1 as a cause and therapeutic target in metabolic disease. Mol Cell Endocrinol 2010; 316: 154-164.