Antenatal Corticosteroids A Risk Factor for the Development of Chronic Disease英文文献资料.docVIP

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Antenatal Corticosteroids A Risk Factor for the Development of Chronic Disease英文文献资料.doc

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Antenatal Corticosteroids A Risk Factor for the Development of Chronic Disease英文文献资料

HindawiPublishingCorporation JournalofNutritionandMetabolism Volume2012,ArticleID930591,9pages doi:10.1155/2012/930591 ReviewArticle AntenatalCorticosteroids:ARiskFactorfor theDevelopmentofChronicDisease ElizabethAsztalos DepartmentofPaediatrics,UniversityofTorontoandTheCentreforMother,Infant,andChildResearch,SunnybrookResearch Institute,SunnybrookHealthSciencesCentre,2075BayviewAvenue,Toronto,ON,CanadaM4N3M5 CorrespondenceshouldbeaddressedtoElizabethAsztalos,elizabeth.asztalos@sunnybrook.ca Received20November2011;Revised30December2011;Accepted31December2011 AcademicEditor:SimonC.Langley-Evans Copyright?2012ElizabethAsztalos.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense, whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited. Pretermbirthremainsamajorhealthissueworldwide.Sincethe1990s,womenatriskforpretermbirthreceivedasinglecourse ofexogenousantenatalcorticosteroids(ACSs)tofacilitatefetallungmaturity.Morerecently,repeatedormultiplecoursesofACS havebeensupportedtoprovidecontinuedfetalmaturitysupport forwomenwithcontinuedriskofpretermbirth.However, exogenousACSreducesbirthweightwhich,inturn,isassociatedwithadverseadultoutcomessuchascoronaryheartdisease, stroke,hypertension,andtype2diabetes.Thelong-terme?ectsofACSexposureonHPAaxisactivityandneurologicalfunction arewelldocumentedinanimalstudies,anditappearsthatACS,regardlessofdoseexposure,iscapableofa?ectingfetalHPA axisdevelopmentcausingpermanentchangesintheHPAaxisthatpersiststhroughlifeandismanifestedbychronicillnessand behavioralchanges.ThechallengeinhumanstudiesistodemonstratewhetheraninterventionsuchasACSadministrationin pregnancycontributestodevelopmentalprogrammingandhowthisismanifestedinlaterlife. 1.Introduction andfetaloverexposuretoglucocorticoidsbothofwhichmay havee?ectseitherdirectlyorindirectlyuponthedeveloping fetus. Exposure to excess glucocorticoids in utero acts to program the fetal hypothalamic-pituitary-adrenal