Bone metabolism in pregnant women exposed to single compared with multiple courses of corticosteroids

Abstract

Objective: To compare markers of maternal bone metabolism between women who received a single compared with multiple courses of antenatal corticosteroids.

Methods: This is an analysis of serum samples from a previously reported randomized, placebo-controlled, multicenter trial. Women at risk for preterm delivery after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone (active) or placebo. Serum levels of carboxy terminal propeptide of type I procollagen (PICP) and cross-linked carboxy terminal telopeptide of type I collagen (ICTP) were measured to assess the rate of bone formation and resorption, respectively, at three time points. The placebo group (n=93) was compared with the active group, receiving four or more courses of betamethasone (n=112).

Results: There were significant (P<.001) increases in PICP and ICTP between baseline and delivery in both groups. Cross-linked carboxy terminal telopeptide of type I collagen, but not PICP, was lower with corticosteroid exposure immediately before administration of the fourth study course (P<.001). No significant differences in PICP and ICTP were seen between groups at delivery.

Conclusion: Increasing levels of PICP and ICTP with advancing gestation are consistent with physiologic changes in maternal bone metabolism. Multiple courses of corticosteroids for fetal maturation are not associated with persistent or cumulative effects on maternal bone metabolism as measured by PICP and ICTP.

Level of evidence: II.

Fig. 1

Serum carboxy terminal propeptide of type I procollagen (PICP) concentration in active and placebo groups (box-and-whisker plot of the log transformed data).

Fig. 2

Serum cross-linked carboxy terminal telopeptide oftype I collagen (ICTP) concentration in active and placebo groups (box-and-whisker plot of the log transformed data).

Fig. 3

Ratio of serum carboxy terminal propeptide of type I procollagen (PICP) to cross-linked carboxy terminal telopeptide of type I collagen (ICTP) concentration in active and placebo groups (box-and-whisker plot of the log transformed data).