PHARMACOLOGICAL AGENTS IN PREGNANCY TO IMPROVE FETAL CONDITIONS - PREVENTION OF FETAL CARDIAC-INSUFFICIENCY, CONSEQUENCES OF CONGENITAL ADRENAL-HYPERPLASIA AND RESPIRATORY-DISTRESS SYNDROME

Improved prenatal diagnostics of fetal diseases have made it necessary to evaluate and develop maternal pharmacological treatment programs t o improve fetal condition. In fetal cardiac insufficiency due to persi stent tachyarrhythmias, maternal treatment, e.g., with either digoxin alone or combined with other drugs, makes it possible to continue preg nancy in preterm patients with risk of fetal cardiac failure and decre ases mortality and morbidity. The loading dose of digoxin can be given either intravenously to the mother or when fetal hydrops is already p resent directly into the fetal buttock. Maternal oral treatment is ini tiated simultaneously and continued until delivery is possible. if no response is achieved in 3 days, other regimens are used. Severe virili zation of female fetuses due to congenital adrenal hyperplasia and 21- hydroxylase deficiency can be prevented by starting oral maternal dexa methasone (1.0-1.5 mg/day) treatment no later than at the 7th week of pregnancy. Later analysis of chorion villous cells at the 10-11th week of pregnancy reveals whether the fetus is affected or healthy. If aff ected, the treatment has to be continued until delivery. Maternal cort icosteroid therapy to prevent respiratory distress syndrome (RDS) of p reterm infants must be given at least 24-48 hours before delivery to g et any benefit. The two regimens used are betamethasone 12 mg twice wi th an interval of 24 hours, and dexamethasone 12 mg twice with an inte rval of 12 hours. Serial treatments with an interval of 7-14 days furt her decrease the risk of RDS, but simultaneously the possibility of si de effects such as fetal growth retardation and postnatal endocrinolog ical disorders increases. (C) 1998 Prous Science. All rights reserved.