medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-10-110-114medsovet-6937Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYАнтенатальное применение глюкокортикостероидов: механизмы программирования здоровья детейAntenatal glucocorticosteroids treatment: mechanisms of child healths programminghttps://orcid.org/0000-0002-8632-3075ШайтароваА. В.ShaitarovaA. V.

Шайтарова Анна Владимировна, кандидат медицинских наук, доцент кафедры педиатрии Института непрерывного профессионального развития

625023, Тюмень, ул. Одесская, д. 54

Anna V. Shaitarova, Cand. Sci. (Med.), Associate Professor of the Department of Pediatrics at the Institute of Continuous Professional Development

54, Odesskaya St., Tyumen, 625023

annashaytarova@mail.ruhttps://orcid.org/0000-0001-9253-8075СуплотоваЛ. А.SuplotovaL. A.

Суплотова Людмила Александровна, доктор медицинских наук, профессор, заведующая курсом эндокринологии кафедры терапии Института непрерывного профессионального развития

625023, Тюмень, ул. Одесская, д. 54

Lyudmila A. Suplotova, Dr. Sci. (Med.), Professor, Head of the Endocrinology course of the Department of Therapy of the Institute of Continuous Professional Development

54, Odesskaya St., Tyumen, 625023

suplotovala@mail.ruТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian Federation202219062022010110114Copyright © Шайтарова А.В., Суплотова Л.А., 20222022Шайтарова А.В., Суплотова Л.А.Shaitarova A.V., Suplotova L.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6937

Синтетические глюкокортикостероиды широко применяются в рутинной медицинской практике в случаях угрозы преждевременных родов и при подозрении на врожденную гиперплазию надпочечников. Доказано снижение показателей смертности недоношенных новорожденных под влиянием данной терапии, а также уменьшение вирилизации наружных гениталий и мозга у плодов женского пола с ВДКН. Врожденная дисфункция коры надпочечников, обусловленная дефицитом 21-гидроксилазы, является распространенным, потенциально летальным заболеванием. Частота заболевания, рассчитанная по данным скрининга новорожденных, составляет 1 случай на 14 000 живых новорожденных среди населения мира, 1 – на 9 638 в России. Дексаметазон проникает через плацентарный барьер, что снижает продукцию АКТГ плода и подавляет фетальную продукцию андрогенов. В то же время предродовое лечение не исключает потребности в пожизненном лечении в будущем и не является профилактикой синдрома потери соли в послеродовом периоде, а безопасность дексаметазона в отношении когнитивного развития детей, пренатально получавших дексаметазон, все еще остается предметом дискуссий. Беспокойство усугубляет тот факт, что дозы дексаметазона, воздействию которых подвергается плод, в 60 раз превышают нормальный уровень кортизола плода. Глюкокортикоидные и минералокортикоидные рецепторы высоко экспрессированы в гиппокампе, миндалевидном теле и префронтальной коре. Эти области, важные для исполнительной деятельности, эмоциональной регуляции, памяти, уязвимы для высоких доз глюкокортикостероидов. Результаты исследований демонстрируют, что антенатальное применение синтетических глюкокортикостероидов ассоциировано с повышенным риском развития метаболических и сердечно-сосудистых нарушений, изменением поведения и когнитивных способностей.

Synthetic glucocorticoids are widely used in pregnancies at risk of preterm delivery and in pregnant women at risk of having a child with severe 21-hydroxylase deficiency. The positive effects of reducing mortality in preterm and virilisation in girls with congenital adrenal hyperplasia are now unquestionable. The adrenogenital syndrome responding to 21-hydroxylase deficiency is a common, potential fatal disease. Its incidence calculated on the basis of neonatal screening data makes 1 case for 14000 live newborns among the worldwide population, 1 for 9638 – In Russia. DEX passes through the placenta and decreases fetal ACTH production thereby suppressing the fetal production of androgens. The prenatal treatment does not preclude from a life-long treatment in future and it is not prevention of a salt-losing syndrome at the postnatal period, and dexamethasone safety in relation to cognitive development of children prenatally treated with dexamethasone is still up for debate. Adding to the concern is the fact that the doses of DEX that the fetus is exposed to are estimated to be 60 times the normal fetal cortisol level. The glucocorticoid and the mineralocorticoid receptors are highly expressed in the hippocampus, amygdala, and prefrontal cortex. These areas, important for executive functioning, emotional regulation, and memory, are vulnerable to high doses of GCs. Most experimental data from animal have shown that prenatal exposure to synthetic glucocorticoids programs the foetal HPA and may lead to altered susceptibility to metabolic and cardiovascular disease i.e. metabolic syndrome, high blood pressure. Prenatal glucocorticoid exposure also leads to modification of HPAassociated behaviours and cognition.

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The authors declare that there are no conflicts of interest present.