Zhanara, если срочно и коротко: делайте. При наличии опасений по поводу зрелости лёгких плода введение кортикостероидов, как показали многочисленные исследования, действительно приносит больше пользы ребёнку, чем вреда ему или матери. Давать сейчас развёрнутый ответ просто нет времени, у меня материала страниц на тридцать. Ничего ужасного там в побочных действиях или осложнениях на самом деле нет.
Если кратко:
Плюсы: заметное (на примерно 30%) сокращение риска РДС (респираторного дистресс-синдрома), сокращение интегральных рисков тяжёлых исходов, небольшое уменьшение веса новорождённого.
Минусы для матери и ребёнка: существенных не отмечено. В долгосрочном плане отмечалось
очень небольшое увеличение инсулинорезистентности и нарушений метаболизма глюкозы во взрослом возрасте.
Не могу не заметить, что в западной практике редко назначают повторные курсы терапии кортикостероидами, обходясь одним курсом введения препарата, поскольку нет данных о том, что увеличение количества курсов существенно влияет на улучшение исхода.
Более подробно, но на английском языке Potential long-term side effectsInfants — A 2006 systematic review of data from randomized trials found that a single course of antenatal corticosteroids did not increase the risk of any adverse infant outcome, including neonatal sepsis, small for gestational age infant, hypothalamic-pituitary-adrenal (HPA) suppression, or air leak syndrome [ 2 ]. However, further research is needed, as several studies of infants exposed to antenatal corticosteroids have observed reduced basal and stress-induced cortisol secretion in these infants [ 65-68 ]; this subject has been reviewed in detail elsewhere [ 69 ].
Children and adults — Follow-up studies at ages 3 to 6, 12, 22, and 30 years have not reported adverse effects on growth, lung function, and psychosexual, motor, cognitive, neurologic, and ophthalmologic outcomes in antenatal corticosteroid exposed children/adults compared with unexposed controls [ 6,70-75 ].
However, other potentially adverse effects have been reported and require further study. For example:
- A cross-sectional study of 209 term-born children at 6 to 11 years of age observed significantly increased cortisol reactivity to acute psychosocial stress in those exposed to antenatal synthetic corticosteroid treatment compared to controls [ 76 ]. It has been hypothesized that antenatal corticosteroids lead to prenatal programming of a hyperactive HPA-axis, which may increase these children’s risk for cardiovascular and affective disorders later in life.
- In the Auckland Steroid Trial, which is the largest and longest follow-up study of individuals exposed to antenatal corticosteroids, 253 adults from betamethasone treated pregnancies and 281 adults from placebo-treated control pregnancies were evaluated at a mean age of 30 years [ 74 ]. Antenatal corticosteroid-exposed adults displayed small, although statistically significant, increases in insulin resistance, but no difference in cardiovascular risk factors compared to unexposed controls. There were no differences between groups in cognitive functioning, working memory and attention, psychiatric morbidity, handedness, or health related quality of life [ 75 ].
- Another long-term outcome study in a British cohort of young adults reported antenatal corticosteroid exposure was associated with increased aortic arch stiffness and altered glucose metabolism in adulthood [ 77 ].
Maternal side effects — Most pregnant women tolerate a single course of antenatal corticosteroids without difficulty. In a systematic review of randomized trials, treatment did not increase the risk of maternal death, chorioamnionitis, or puerperal sepsis [ 2 ]. Case reports have described pulmonary edema, primarily associated with combination treatment with tocolytics, especially in the setting of chorioamnionitis, fluid overload, or multiple gestation [ 78-80 ]. Betamethasone itself has low mineralocorticoid activity compared to other corticosteroids; therefore, hypertension is not a contraindication to therapy [ 81 ].
Transient hyperglycemia occurs in many women; the steroid effect begins approximately 12 hours after the first dose and may last for five days. Screening for gestational diabetes, if indicated, should be performed either before corticosteroid administration or at least five days after the first dose [ 82,83 ]. Hyperglycemia can be severe in the diabetic gravida if not closely monitored and treated.
The total leukocyte count increases by about 30 percent within 24 hours after betamethasone injection, and the lymphocyte count significantly decreases [ 84,85 ]. These changes return to baseline values within three days, and complicate interpretation of the white blood cell count in women suspected of infection.
Рожайте здорового малыша, и пусть всё будет хорошо.
P.S. Когда родите - приходите на форум, я Вас отругаю за то, что рассчитываете на помощь форума в срочной ситуации.
Жизнь делится на два этапа — сначала нет ума, потом здоровья.