Glicocorticoides sintéticos e gestação: efeitos in e ex útero

Abstract

Global estimates indicate that annually more than 15 million babies are born because of preterm birth (PTB), accounting for about 5 to 18% of all global births. Poor maternal adaptation to psychosomatic and social changes, as well as an increased likelihood of genitourinary tract infections during pregnancy, can lead to a higher incidence of PTB. The use of glucocorticoids (GC) during pregnancy is increasingly growing to enhance neonatal survival rates in pregnancies at high risk of PTB, but also to increase the success rate of assisted reproduction treatments and to prevent virilization of female fetuses with congenital adrenal hyperplasia (CAH). Therefore, the aim of this study was to describe the most used gestational GC therapies in Brazil and around the world, and the therapeutic and undesirable effects of gestational synthetic GC (sGC) use, for fetus and pregnancy. For this purpose, a systemic review was conducted by searching for articles using DeCS/MeSH descriptors in several databases (PubMed, Google Scholar, among others). The study analyzed the use of GC during pregnancy, highlighting their importance in improving neonatal survival in pregnancies at high risk of PTB and in other clinical situations. However, the need for a careful evaluation before starting GC therapy is noted, including confirming the diagnosis of the underlying disease, the severity of the condition, ruling out infections, and assessing risks such as diabetes and hypertension. GC are beneficial for fetal lung maturation, reducing the risk of respiratory problems in preterm infants. However, the lesser-known side effects of in útero sGC therapy may include neurobehavioral, endocrine, or metabolic problems that may emerge later in life. The immediate benefits of GCs must be balanced against the potential long-term risks to child development. It is of great importance to conduct longitudinal research to fully understand the impacts of antenatal GC therapy and develop strategies to minimize adverse effects, aiming to optimize treatment for the best outcomes for the mother and the baby.