Dataset Information

Short-Term Effects of Dexamethasone versus Betamethasone on Ultrasonic Measures of Fetal Well-Being: Cohort from a Blinded, Randomized Trial.

ABSTRACT:

Introduction

Maternal corticosteroid administration for anticipated preterm birth is common; however, the corticosteroid effect on fetal ultrasound and cardiotocograph (CTG) remains contested. This study aimed to evaluate short-term ultrasound and CTG impact of (a) dexamethasone versus betamethasone (b) pooled corticosteroid effect.

Methods

Substudy of blinded randomized trial of dexamethasone versus betamethasone (given <34 weeks). Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and uterine artery Doppler, myocardial performance index (MPI), biophysical profile (BPP), and CTG measured pre-corticosteroid then 1, 2, 4, and 7 days post-corticosteroid.

Results

Of 47 fetuses (39 singleton; 4 dichorionic, diamniotic twins; and 4 monochorionic, diamniotic twins) in the February 2012-2013 period, 24 received dexamethasone and 23 betamethasone at average gestation 29.8 ± 2.9 weeks. Thirteen pregnancies (30%) had pre-corticosteroid fetal concerns (estimated weight <10th centile and/or abnormal UA/MCA Doppler). Few significant differences were seen post-corticosteroid: DV pulsatility index and right MPI initially decreased 15-20%, and average BPP decreased slightly on days 1-2. There were no major differential effects of dexamethasone versus betamethasone.

Discussion/conclusion

No substantive post-corticosteroid effects were seen for most ultrasound/CTG measures in fetuses with heightened preterm birth risk but predominantly normal pre-corticosteroid measures. Clinically, this suggests avoiding overreliance on individual measures for delivery decisions post-corticosteroid; equally, multiple/marked ultrasound changes suggest true pathology and not corticosteroid effect.

SUBMITTER: Henry A

PROVIDER: S-EPMC8491495 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Background: Subjective well-being refers to the extent to which a person believes or feels that her life is going well. It is considered as one of the best available proxies for a broader, more canonical form of well-being. For over 30 years, one important distinction in the conceptualization of subjective well-being is the contrast between more affective evaluations of biological emotional reactions and more cognitive evaluations of one's life in relation to a psychologically self-imposed ideal. More recently, researchers have suggested the addition of harmony in life, comprising behavioral evaluations of how one is doing in a social context. Since measures used to assess subjective well-being are self-reports, often validated only using Classical Test Theory, our aim was to focus on the psychometric properties of the measures using Item Response Theory. Method: A total of 1000 participants responded to the Positive Affect Negative Affect Schedule. At random, half of the participants answered to the Satisfaction with Life Scale or to the Harmony in life Scale. First, we evaluate and provide enough evidence of unidimensionality for each scale. Next, we conducted graded response models to validate the psychometric properties of the subjective well-being scales. Results: All scales showed varied frequency item distribution, high discrimination values (Alphas), and had different difficulty parameters (Beta) on each response options. For example, we identified items that respondents found difficult to endorse at the highest/lowest point of the scales (e.g., "Proud" for positive affect; item 5, "If I could live my life over, I would change almost nothing," for life satisfaction; and item 3, "I am in harmony," for harmony in life). In addition, all scales could cover a good portion of the range of subjective well-being (Theta): -2.50 to 2.30 for positive affect, -1.00 to 3.50 for negative affect, -2.40 to 2.50 for life satisfaction, and -2.40 to 2.50 for harmony in life. Importantly, for all scales, there were weak reliability for respondents with extreme latent scores of subjective well-being. Conclusion: The affective component, especially low levels of negative affect, were less accurately measured, while both the cognitive and social component were covered to an equal degree. There was less reliability for respondents with extreme latent scores of subjective well-being. Thus, to improve reliability at the level of the scale, at the item level and at the level of the response scale for each item, we point out specific items that need to be modified or added. Moreover, the data presented here can be used as normative data for each of the subjective well-being constructs.