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The Influence of Corticosteroids on Fetal Heart Rate Variability: A Systematic Review of the Literature

Verdurmen, Kim M. J. MD*; Renckens, Joris BSc*; van Laar, Judith O. E. H. MD, PhD; Oei, S. Guid MD, PhD

Obstetrical & Gynecological Survey: December 2013 - Volume 68 - Issue 12 - p 811–824
doi: 10.1097/OGX.0000000000000007

Corticosteroids play an important role in the clinical management of threatened preterm delivery between 24 and 34 weeks of gestational age. It is known that corticosteroids have a direct, transient effect on fetal heart rate (fHR) parameters. Fetal heart rate variability is a reflection of autonomic nervous system activity and a useful marker for fetal well-being. Therefore, it is important to interpret the changes that occur in fHR parameters during corticosteroid treatment correctly, to avoid unnecessary iatrogenic preterm delivery. We performed a systematic review of the literature in CENTRAL, PubMed, and EMBASE, including 15 articles. In this review, we discuss the influence of corticosteroids on fHR parameters, in particular fHR variability, and fetal behavior. Furthermore, we explain possible mechanisms of action and confounding factors.

Target Audience: Obstetricians and gynecologists, family physicians

Learning Objectives: After completing this CME activity, physicians should be better able to describe the changes in fHR parameters and fetal behavior that occur after corticosteroid administration and describe the time course of these changes, evaluate the underlying mechanisms causing these changes, assess possible confounding factors, and identify the pitfalls causing iatrogenic preterm labor after corticosteroid administration.

*Clinical Researcher, †Resident, and ‡Professor, the Department of Obstetrics & Gynecology, Máxima Medical Center, Veldhoven, the Netherlands

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Kim M. J. Verdurmen, MD, Department of Obstetrics and Gynecology, Máxima Medical Center Veldhoven, PO Box 7777, 5500 MB Veldhoven, the Netherlands. E-mail:

© 2013 by Lippincott Williams & Wilkins.