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Effects on maternal platelet variables of betamethasone administered to achieve fetal lung maturity

Thrombocytopenia in the pregnant patient may result from a number of causes, most of which involve either immune-mediated platelet (PTL) destruction or PTL consumption and 15% of thrombocytopenias in pregnancy are represented by the ‘‘incidental thrombocytopenia of pregnancy’’ [1] which is a benign condition of unknown aetiology and which resolves within a few days of delivery. Corticosteroids are thought to represent the choice treatment for thrombocytopenia in pregnancy. The aim of this study was to evaluate the effect of betamethasone administered for fetal lung maturity (FLM) on PTL parameters in a group of pregnant women affected by threatened preterm labour. We considered 147 third trimester pregnancies admitted with a diagnosis of threatened preterm delivery from January 2001 to December 2006 at our Institute who satisfied the following inclusion criteria: single thid trimester pregnancies (24–34 weeks’ gestation), negative PROM (fibronectin in vaginal fluid sample) test, negative cervix-vaginal specimens for common microorganisms of the lower genital tract (Candida albicans, Gardnerella vaginalis, Chlamydia trachomatis, Mycoplasm and Ureaplasma urealiticum), body temperature less than 37 , normal maternal biochemical parameters (white blood cell count 5 15000/mm), PCR lower than 2 mg/100 ml, normal maternal and fetal Doppler velocimetry, absence of uterine contractions after tocolitic therapy and delivery at term without evidence of pregnancy (i.e., diabetes, hypertension, intrauterine growth restriction, etc.) and neonatal complications (birthweight 4 2500 g, not admission at NICU, Apgar score47 at 50). In all pregnant women, administration of one course of betamethasone (12 mg i.m. for two consecutive days) for FLM promotion was performed. All 147 selected patients completed the betamethasone course. Whole venous blood was obtained from the antecubital vein shortly after Doppler velocimetry evaluation. Maternal blood sampling for PTL variables: PTL counts (PLT), mean PTL volume (MPV), PCT and PDW evaluation were performed as previously described [2] within 24 h before steroid therapy and at 24, 48 and 72 h after the second dose of betamethasone in the entire group. In all but four cases, endovenous tocolytic therapy with miolene e.v. (Ritodrine 10 mg/100 ml) was started at admission and continued up to 12 h after contractions cessation. After symptoms resolved, all pregnancies were dismissed in good conditions and subsequently delivered in our Institute at term (mean gestational age at delivery 38.4 1.3 weeks gestation). PTL parameters were analysed in a repeated measure fashion (before three consecutive daily samplings after steroid cycle). No statistical differences were found for all PTL parameters before and after betamethasone administration. When MPV values at different periods from the second dose (24, 48 and 72 h) were analysed with respect to baseline values, only a significant nonetheless transient reduction 24 h after steroid therapy was observed (Table I). A reduced PTL count is common in pregnancy. The investigators believe that PTL consumption may signify an inflammatory response. Therefore, by decreasing inflammation, corticosteroids may be an effective treatment for thrombocytopenia in pregnant women. A recent study performed by Giannubilo et al. [3] observed that steroids may have a role in the treatment of thrombocytopenia