A multidisciplinary group of researchers at Wake Forest Baptist Medical Center has received a $7.3 million grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) to continue for another five years its investigation into the health consequences of exposure to steroids before birth.
A significant development in prenatal care over the last 30 years has been the treatment of pregnant women at risk for premature delivery with synthetic versions of glucocorticoids, a class of steroid hormones, to facilitate lung development in fetuses and thereby greatly increase their chances of survival. However, data collected from studies of both animals and humans have raised concerns that fetuses exposed to this particular type of steroid may be “programmed” for adult-onset disease.
The project’s principal investigator, James C. Rose, Ph.D., director of the Center for Research in Obstetrics and Gynecology at Wake Forest Baptist, and his colleagues are studying the programming effects of prenatal steroid exposure in sheep and in a group of adolescents.
Over the past five years, Rose said, the researchers have found that sheep exposed to these steroids before birth may exhibit early signs of risk factors predisposing them to kidney problems, alterations in the regulation of blood sugar and impairments in the mechanisms that control blood pressure. Thus, they may be at greater risk of developing high blood pressure and diabetes as they age.
The researchers observed some similar effects in a group of children studied at 14 years of age, suggesting that these adolescents should be followed for the early onset of risk factors for cardiometabolic disorders such as high blood pressure and diabetes, said Lisa Washburn, M.D., associate professor of pediatrics at Wake Forest Baptist. She headed this part of the research project, which included children who were and were not exposed to the steroids before birth.
The new funding from NICHD will allow the researchers to examine the mechanisms of steroid-induced alterations in kidney function and insulin resistance and to explore the possibility that obesity can act as a “second hit” that exacerbates the effects of prenatal steroid exposure.
“Our hypothesis is that the adverse programming effects of prenatal steroids will be greater in offspring who are obese,” Rose said. “If this proves to be the case, our studies will identify an at-risk population and a modifiable risk factor.”
That, Rose said, could promote the identification of new early-intervention strategies to reduce the risk of high blood pressure, kidney problems and metabolic abnormalities in individuals exposed to steroids before birth.
The 13-member team includes researchers from Wake Forest Baptist’s obstetrics and gynecology department, pediatrics department, public health sciences division and Hypertension and Vascular Research Center and Wake Forest University’s health and exercise science department.
The NICHD, established in 1962, is one of the 27 institutes and centers that make up the National Institutes of Health, a division of the U.S. Department of Health and Human Services. It conducts and supports research dealing with fertility, pregnancy, growth, development and medical rehabilitation.