Personalized Antenatal Corticosteroid Therapy and Central Nervous System Development: Reflections on the Gold Standard of Fetomaternal Therapy

Abstract

Background: The term "fetal programming" refers to the effects of endogenous and exogenous corticosteroids, whether received from the mother or the fetus, on brain development and the hypothalamic-pituitary-adrenal axis reset. The authors of this narrative review examine the WHO's guidelines for prenatal corticosteroids in pregnant women who are at high risk of premature delivery. These guidelines are regarded as the best available for preventing late-life problems resulting from preterm.

Methods: In order to find full-text publications published in peer-reviewed journals between 1990 and 2023 that were written in English, the authors searched PubMed, Scopus, Cochrane Library, and Web of Science.

Results: The authors highlight the possible adverse long-term effects of prenatal corticosteroid medication on human brain development and function. This pharmacological feature is therapeutically significant because there is less evidence in the scientific literature regarding the potential role that the timing, mode, and dosage of exogenous steroid treatment may have in neurological illnesses down the road.

Conclusions: The authors expect that these studies will shed light on the relationship between specially designed prenatal corticosteroid therapy and the molecular mechanisms underlying the prenatal programming of neurodevelopment in childhood and adulthood.

Keywords: fetal brain neurodevelopment; fetal programming; fetus; glucocorticoids; personalized antenatal corticosteroid therapy; pregnancy.

Figure 1

Developmental programming of neurobehavioral pathologies (Legend: HPA—hypothalamus–pituitary–adrenal; 11β-HSD1—11β-hydroxysteroid dehydrogenase type-1; 11β-HSD2—11β-hydroxysteroid dehydrogenase type-2).