Short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status: A quasi-experimental observational (before-after) study


Background: The administration of antenatal corticosteroid is a standard treatment to reduce the rate of perinatal mortality and morbidity; however, there is limited evidence regarding the potential effects of betamethasone on the constriction of the ductus arteriosus (DA).

Objective: This study aimed to investigate the short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status.

Materials and Methods: This quasi-experimental observational (before-after) study was conducted on 32 singleton fetuses. The participants were healthy pregnant women with a diagnosis of placenta accreta spectrum who were eligible for 2 doses of betamethasone and referred to prenatal care clinic, Vali-E-Asr hospital; Tehran, Iran from January 2021-May 2022. The results of fetal echocardiography and Doppler sonography were compared before and after the administration of antenatal corticosteroid therapy.

Results: Following betamethasone injection, significant increases were observed in peak systolic and diastolic velocity of the DA without constriction of the DA (p < 0.001, p = 0.002 respectively). However, no significant changes were observed in right ventricular function, tricuspid valve function, Doppler of ductus venous, and peak systolic velocity of the aortic isthmus (p > 0.05). Doppler examination of the uterine, umbilical, and middle cerebral arteries also showed no significant changes (p > 0.05).

Conclusion: Considering the benefits of antenatal corticosteroid therapy, its administration seems reasonable in preterm births. The transient changes in ductal blood flow are not prohibitive.

Key words: Betamethasone, Premature birth, Ultrasonography, Doppler, Echocardiography, Fetus.

[1] Di Renzo GC, Cabero Roura L, Facchinetti F, Helmer H, Hubinont C, Jacobsson B, et al. Preterm labor and birth management: Recommendations from the European Association of Perinatal Medicine. J Maternal Fetal Neonatal Med 2017; 30: 2011–2030.

[2] Romero R, Dey SK, Fisher SJ. Preterm labor: One syndrome, many causes. Science 2014; 345: 760–765.

[3] WHO. Preterm Birth. 2022. Available at: preterm-birth. (accessed on 1 January 2023)

[4] Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454.

[5] Schmitz T. [Prevention of preterm birth complications by antenatal corticosteroid administration]. J Gynecol Obstet Biol Reprod 2016; 45: 1399–1417. (in French)

[6] Vadivelu P, Keepanasseril A, Plakkal N. Improvement of cardiac function in fetuses with growth restriction following antenatal betamethasone administration: Fact or artifact? J Maternal Fetal Neonatal Med 2021; 34: 3306–3312.

[7] Vrselja A, Pillow JJ, Black MJ. Effect of preterm birth on cardiac and cardiomyocyte growth and the consequences of antenatal and postnatal glucocorticoid treatment. J Clin Med 2021; 10: 3896.

[8] Henry A, Shand A, Welsh A. The short term fetal cardiovascular effects of corticosteroids used in obstetrics. Aust J Ultrasound Med 2013; 16: 135–141.

[9] Choi EY, Li M, Choi CW, Park KH, Choi JY. A case of progressive ductal constriction in a fetus. Korean Circ J 2013; 43: 774–781.

[10] Lopes LM, Carrilho MC, Francisco RP, Lopes MA, Krebs VL, Zugaib M. Fetal ductus arteriosus constriction and closure: Analysis of the causes and perinatal outcome related to 45 consecutive cases. J Maternal Fetal Neonatal Med 2016; 29: 638–645.

[11] Ferraz MM, Araújo FD, Carvalho PR, Sá RA. Aortic isthmus Doppler velocimetry in fetuses with intrauterine growth restriction: A literature review. Rev Bras Ginecol Obstet 2020; 42: 289–296.

[12] Shelton EL, Waleh N, Plosa EJ, Benjamin JT, Milne GL, Hooper CW, et al. Effects of antenatal betamethasone on preterm human and mouse ductus arteriosus: Comparison with baboon data. Pediatr Res 2018; 84: 458–465.

[13] Azancot-Benisty A, Benifla J, Matias A, De Crepy A, Madelenat P. Constriction of the fetal ductus arteriosus during prenatal betamethasone therapy. Obstet Gynecol 1995; 85: 874–876.

[14] Kemmotsu T, Yokoyama U, Saito J, Ito S, Uozumi A, Nishimaki S, et al. Antenatal administration of betamethasone contributes to intimal thickening of the rat ductus arteriosus. Circ J 2019; 83: 654–661.

[15] Lee MJ, Guinn D, Martin R. Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery. UpToDate; 2018. (preprint)

[16] Abuhamad AZ, Chaoui R. A practical guide to fetal echocardiography: Normal and abnormal hearts. Philadelphia: Lippincott Williams & Wilkins; 2020.

[17] Kähler C, Schleussner E, Möller A, Seewald H-J. Doppler measurements in fetoplacental vessels after maternal betamethasone administration. Fetal Diagn Ther 2004; 19: 52–57.

[18] Agnew EJ, Ivy JR, Stock SJ, Chapman KE. Glucocorticoids, antenatal corticosteroid therapy and fetal heart maturation. J Mol Endocrinol 2018; 61: 61–73.

[19] Smolich JJ, Kenna KR, Mynard JP. Antenatal betamethasone augments early rise in pulmonary perfusion at birth in preterm lambs: Role of ductal shunting and right ventricular outflow distribution. Am J Physiol Regul Integr Comp Physiol 2019; 316: 716–724.

[20] Pedersen LH, Mogra R, Hyett J. Effect of corticosteroids on cardiac function in growth-restricted fetuses. Ultrasound Obstet Gynecol 2016; 48: 204–209.

[21] Marchi L, Pasquini L, Elvan-Taspinar A, Bilardo CM. Cardiovascular hemodynamic changes after antenatal corticosteroids in growth restricted and appropriate for gestational age fetuses. Ultraschall Med 2020; 41: 292– 299.

[22] Thuring A, Malcus P, Maršál K. Effect of maternal betamethasone on fetal and uteroplacental blood flow velocity waveforms. Ultrasound Obstet Gynecol 2011; 37: 668–672.

[23] Özdemir H, Hansu K, Çal??s P, Karçaalt??ncaba D, Bayram M. Does betamethasone therapy impact fetal multivessel Doppler parameters? Prenat Cardiol 2021; 2021: 18–23.

[24] Ekin A, Gezer C, Solmaz U, Taner CE, Ozeren M, Dogan A, et al. Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: A prospective study. J Perinatal Med 2016; 44: 243–248.

[25] Vafaei H, Kaveh Baghbahadorani F, Asadi N, Kasraeian M, Faraji A, Roozmeh S, et al. The impact of betamethasone on fetal pulmonary, umbilical and middle cerebral artery Doppler velocimetry and its relationship with neonatal respiratory distress syndrome. BMC Pregnancy Childbirth 2021; 21: 188.

[26] Acharya G. Technical aspects of aortic isthmus Doppler velocimetry in human fetuses. Ultrasound Obstet Gynecol 2009; 33: 628–633.