Adult Males of Very Low Birth Weight with Antenatal Corticosteroid Exposure Exhibit an Enhanced Blood Pressure Response to Acute Stress
Authors: Washburn Lisa , Chappell Mark , Beavers Daniel , Diz Debra , Jensen Elizabeth , Nixon Patricia , Shaltout Hossam , South Andrew , Taylor Robert , Rose James 
Published: November 2023

Antenatal corticosteroid (ANCS) treatment improves mortality and morbidity in preterm infants born with very low birth weight (VLBW; <1500g) and ANCSs are administered to approximately 100,000 pregnant women in the US each year. However, the long term effects of ANCS on cardiovascular indices such as blood pressure in the adult are not well characterized. The blood pressure response to acute stress may be an indicator of dysregulation of the cardiovascular system. We hypothesized that ANCS exposure (ANCS+) would be associated with a greater blood pressure response to mental stress compared to those without ANCS (ANCS−) in young adults born with VLBW. Using oscillometry (Dinamap Pro 100) we assessed systolic blood pressure (SBP) at baseline (average of 3 measures) and every 2 minutes during a 10 minute period of mental stress in a cohort of 153 young adults (66 male, 69 black). We used t‐tests to compare the characteristics of those with and without ANCS and generalized linear models to evaluate the association between ANCS exposure and SBP, adjusted for race. There were no group differences (mean ± std) in gestational age (ANCS− vs. ANCS+: 28.2 ± 2.9 vs. 27.7 ± 2.4 weeks), birth weight (1095 ± 265 vs. 1028 ± 277 g), or birth weight Z score (−0.27 ± 1.0 vs. −0.31 ± 0.7). Participant characteristics at young adulthood are shown in the Table. In our assessment between ANCS exposure and SBP, with adjustment for race, we observed no significant association between ANCS exposure and pre‐stress SBP, stress SBP, or change in SBP in response to stress, 0.79 mmHg (95% CI: −4.01, 2.50), 1.19 mmHg (95% CI: −3.19, 5.57) and 1.98 mmHg (95% CI: −.83, 4.78) respectively. However, stratified analysis revealed sex differences in response to stress with ANCS+ males exhibiting a higher SBP response to stress (6.45 mmHg; 95% CI: 2.20, 10.70) compared to females (−1.53 mmHg; 95% CI: −5.20, 2.14). In summary, we observed that ANCS exposure is associated with a higher SBP response to mental stress in adult males who were born with VLBW. Further follow up is warranted to evaluate whether there may be increased risk for altered blood pressure regulation among those exposed to ANCS.Support or Funding InformationNICHD P01 HD047584 Clinical Research Unit of Wake Forest Baptist Medical Center MO1‐RR07122 from NCRR/NIH Wake Forest School of Medicine Department of Pediatrics

Characteristics of young adults born with very low birth weight by ANCS exposure

ENTIRE GROUP
MALE
FEMALE

ANCS−n=81mean±std
ANCS+n=72mean±std
ANCS−n=34mean±std
ANCS+n=32mean±std
ANCS−n=47mean±std
ANCS+n=40mean±std

Age, yrs
19.5±0.9*
19.1±0.9
19.6±1.1
19.3±1.0
19.4±0.7*
18.9±0.8

Weight, kg
72.8±23.5
70.5±20.9
79.3±25.2
77.8±20.9
68.1±21.2
64.6±19.2

Height, cm
163.8±10.1
165.8±9.4
170.2±9.9
173.8±5.5
159.3±7.2
159.2±6.5

Pre‐stress SBP, mmHg
116.7±10.9
115.4±9.0
120.1±11.8
118.4±8.5
114.3±9.7
112.9±8.8

Stress SBP, mmHg
127.3±12.9
128.8±13.7
128.9±14.1
134.5±14.3
126.1±11.9
124.2±11.5

Δ SBP, mmHg
10.6±8.2*
13.4±9.3
8.8±7.7*
16.1±9.6
11.8±8.4
11.3±8.5

p<0.05 for assessment of difference in means between ANCS− and ANCS+