母亲孕期使用吸入糖皮质激素不影响胎儿糖皮质激素的调节通路
2011/04/15
背景：目前对孕妇怀孕期间哮喘发作推荐使用的还是吸入糖皮质激素（ICS），但是对于孕期吸入ICS对母体、胎盘及胎儿的全身系统性的潜在影响还缺乏相关证据。
目的：研究哮喘孕妇与非哮喘孕妇孕期母体血浆中皮质醇，雌三醇，骨钙素和促肾上腺皮质激素释放激素（CRH）的水平。
方法：在孕期的各个阶段记录ICS的使用情况和剂量并采集血标本，孕18周和30周行胎儿超声检测，分娩时记录婴儿出生体重和性别。
结果：哮喘与否不影响母体血浆中激素水平，但ICS可抑制母体激素水平，且与ICS使用剂量相关。胎儿性别对母体激素水平有不同影响：如果怀的是女婴，ICS与孕期第一阶段（11-15周）母体皮质醇水平及第二（16-24周）、第三阶段（25-34周）骨钙素水平呈负相关；如果怀的是男婴，则没发现ICS剂量对母体皮质醇，雌三醇或骨钙素水平有任何影响，在第一阶段发现ICS使用可增加CRH的水平。
结论：怀有女婴的母体糖皮质激素调节系统对ICS较为敏感，而无论怀有男婴女婴，胎儿的肾上腺功能均不受ICS影响。该研究为临床提供了重要的信息，表明哮喘孕妇吸入ICS不影响胎儿的糖皮质激素调节通路，因此不会对胎儿的生长发育造成不良影响。
（浙江大学附属第二医院呼吸科 王苹莉 摘译）
（Am J Respir Crit Care Med. 2010 Oct 8. [Epub ahead of print]）
Fetal Glucocorticoid Regulated Pathways are not Affected by Inhaled Corticosteroid use for Asthma During Pregnancy.
Hodyl NA, Stark M, Osei-Kumah A, Bowman M, Gibson P, Clifton VL.
Am J Respir Crit Care Med. 2010 Oct 8. [Epub ahead of print]
RATIONALE: Inhaled corticosteroids (ICS) are currently advised for the control of asthma during pregnancy, despite the lack of evidence regarding potential systemic effects on maternal, placental and fetal systems.
OBJECTIVES: To determine maternal plasma concentrations of cortisol, estriol, osteocalcin and corticotropin releasing hormone in pregnant women with asthma (n=156) and without asthma (n=51).
METHODS: During each trimester of pregnancy, the use and dose of ICS was recorded and blood samples were collected. Ultrasound was performed at 18 and 30 weeks gestation, and birth weight and fetal sex were recorded at delivery.
MEASUREMENTS AND MAIN RESULTS: Maternal hormone concentrations were not affected by the presence of asthma, however were inhibited by ICS use in a dose dependent manner. This was dependent on fetal sex: in pregnancies with a female, ICS was inversely associated with maternal cortisol in first trimester and inversely associated with maternal osteocalcin in second and third trimester. When pregnant with a male, no effect of ICS dose was observed on maternal cortisol, estriol or osteocalcin levels, while CRH levels were increased with ICS use only in first trimester.
CONCLUSIONS: Maternal glucocorticoid regulated systems appeared susceptible to ICS only when pregnant with a female. Fetal adrenal function appeared unaffected by ICS in pregnancies of both males and females. This provides clinically important information suggesting that ICS do not exert effects on glucocorticoid regulated pathways in the fetus, and therefore are unlikely to contribute to adverse effects on fetal growth and development.
