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

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; B. Arabin; C. M. Bilardo; C. Brezinka; A. Diemert; J. J. Duvekot; W. Ganzevoort; N. Marlow; P. Martinelli; E. Ostermayer; A. T. Papageorghiou; D. Schlembach; K. T. M. Schneider; B. Thilaganathan; J. Thornton; T. Todros; A. Valcamonico; A. van Wassenaer-Leemhuis; A. Aktas; S. Borgione; R. Chaoui; J. M. J. Cornette; T. Diehl; J. van Eyck; I. C. van Haastert; S. Lobmaier; E. Lopriore; H. Missfelder-Lobos; G. Mansi; P. Martelli; G. Maso; U. Maurer-Fellbaum; N. Mensing van Charante; S. Mulderde Tollenaer; R. Napolitano; M. Oberto; D. Oepkes; L. S. Scheepers; M. Spaanderman; TRUFFLE Group Collaborating Authors

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

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, B. Arabin, C. M. Bilardo, C. Brezinka, A. Diemert, J. J. Duvekot, W. Ganzevoort, N. Marlow, P. MartinelliE. Ostermayer, A. T. Papageorghiou, D. Schlembach, K. T. M. Schneider, B. Thilaganathan, J. Thornton, T. Todros, A. Valcamonico, A. van Wassenaer-Leemhuis, A. Aktas, S. Borgione, R. Chaoui, J. M. J. Cornette, T. Diehl, J. van Eyck, I. C. van Haastert, S. Lobmaier, E. Lopriore, H. Missfelder-Lobos, G. Mansi, P. Martelli, G. Maso, U. Maurer-Fellbaum, N. Mensing van Charante, S. Mulderde Tollenaer, R. Napolitano, M. Oberto, D. Oepkes, L. S. Scheepers, M. Spaanderman, TRUFFLE Group Collaborating Authors

^*Corresponding author for this work

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

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 - European Journal of Ultrasound
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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Cite this

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., Arabin, B., Bilardo, C. M., Brezinka, C., Diemert, A., Duvekot, J. J., Ganzevoort, W., Marlow, N., ... TRUFFLE Group Collaborating Authors (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 - European Journal of Ultrasound, 42(01), 56-64. https://doi.org/10.1055/a-0972-1098

@article{721903a80a96420e8be0dcf0ec1540eb,

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 = "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 Scheepers, {L. S.} and M. Spaanderman and {TRUFFLE Group Collaborating Authors}",

year = "2021",

month = feb,

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

language = "English",

volume = "42",

pages = "56--64",

journal = "Ultraschall in der Medizin - European Journal of Ultrasound",

issn = "0172-4614",

publisher = "Georg Thieme Verlag",

number = "01",

}

Fratelli, N, Prefumo, F, Wolf, H, Hecher, K, Visser, GHA, Giussani, D, Derks, JB, Shaw, CJ, Frusca, T, Ghi, T, Ferrazzi, E, Lees, CC, Arabin, B, Bilardo, CM, Brezinka, C, Diemert, A, Duvekot, JJ, Ganzevoort, W, Marlow, N, Martinelli, P, Ostermayer, E, Papageorghiou, AT, Schlembach, D, Schneider, KTM, Thilaganathan, B, Thornton, J, Todros, T, Valcamonico, A, van Wassenaer-Leemhuis, A, Aktas, A, Borgione, S, Chaoui, R, Cornette, JMJ, Diehl, T, van Eyck, J, van Haastert, IC, Lobmaier, S, Lopriore, E, Missfelder-Lobos, H, Mansi, G, Martelli, P, Maso, G, Maurer-Fellbaum, U, van Charante, NM, Tollenaer, SM, Napolitano, R, Oberto, M, Oepkes, D, Scheepers, LS, Spaanderman, M & TRUFFLE Group Collaborating Authors 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 - European Journal of Ultrasound, vol. 42, no. 01, pp. 56-64. https://doi.org/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. / Fratelli, Nicola; Prefumo, Federico; Wolf, Hans et al.
In: Ultraschall in der Medizin - European Journal of Ultrasound, Vol. 42, No. 01, 02.2021, p. 56-64.

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

TY - JOUR

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

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 - Scheepers, L. S.

AU - Spaanderman, M.

AU - TRUFFLE Group Collaborating Authors

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

C2 - 31476786

SN - 0172-4614

VL - 42

SP - 56

EP - 64

JO - Ultraschall in der Medizin - European Journal of Ultrasound

JF - Ultraschall in der Medizin - European Journal of Ultrasound

IS - 01

ER -