Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial).

OBJECTIVES: To determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced. DESIGN: A questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005). SETTING: Four UK study centres from the original trial. PARTICIPANTS: 862 participants from the four largest recruiting centres, 92% of the original study. 824 (96%) were traced and 799 (93%) were successfully contacted. Fifty-one percent (407/799) completed and returned the questionnaire. The children were aged 8-15 years (median 12.2 years, 52% girls). 386 gave consent to contact schools with 352 (91%) reports received. MAIN OUTCOME MEASURES: Questionnaires including a strengths and difficulties questionnaire, International Study of Asthma and Allergies in Childhood, general health and school performance. RESULTS: There were no significant differences between children whose mothers received betamethasone and controls for the mean total strengths and difficulties questionnaire scores and subscores for hyperactivity, emotional symptoms, prosocial behaviour, conduct or peer problems. 25 (12%) children whose mothers received betamethasone had reported learning difficulties compared with 27 (14%) control children. The proportion of children who achieved standard assessment tests KS2 exams level 4 or above for mathematics, English or science was similar as were the rates of ever reported wheeze (30% vs 30%), asthma (24% vs 21%), eczema (34% vs 37%) and hay fever (25% vs 27%). CONCLUSIONS: Antenatal betamethasone did not result in any adverse outcomes or reduction in asthma or atopy. It should be considered for elective CS at 37-38 weeks of gestation. TRIAL REGISTRATION: : Original trial was preregistration, the trial publication is BMJ. 2005 Sep 24;331(7518):662.

Antinuclear antibodies and clinical associations in a british cohort with limited cutaneous systemic sclerosis.

OBJECTIVE: To assess the prevalence of disease-specific autoantibodies in patients with limited cutaneous systemic sclerosis (lcSSc). METHODS: Sera from 180 patients with lcSSc were analyzed for antinuclear antibody (ANA). Clinical characteristics were compared in the presence or absence of specific autoantibodies. RESULTS: SSc-specific antibodies were detected in 135 patients (75%). Associations were found between anticentromere antibody and age at lcSSc diagnosis, telangiectasia, reduced creatinine clearance, and selective reduction in DLCO, and between antitopoisomerase-I and pulmonary fibrosis. CONCLUSION: The majority of patients with lcSSc belong to distinctive serologic subsets, potentially with prognostic significance.

Influence of clinical features on the health status of patients with limited cutaneous systemic sclerosis.

OBJECTIVE: To determine the effect of limited cutaneous systemic sclerosis (lcSSc) on patients' health status, and to identify the contributions to health status of different manifestations of lcSSc. METHODS: The Short Form 36 questionnaire was completed by 213 patients with lcSSc or Raynaud's syndrome and an antinuclear antibody typical of lcSSc as part of the baseline visit of the Quinapril in Scleroderma trial. Results were analyzed after correcting for age and sex using the Welsh Health Survey. Patients' results were related to their clinical characteristics. RESULTS: The mean physical component score (PCS) was 44.0 (95% confidence interval [95% CI] 42.5, 45.5), which was lower than the population norm of 50, and the median mental component score (MCS) was 52.2 (95% CI 48.5, 54.3). Raynaud's disease visual analog scale (VAS) scores, lung function, the number of organ systems affected, and skin score were significantly correlated with PCS. The total score (TDS) of an SSc severity scale showed the highest correlation. The effect of lcSSc on PCS was worse in younger patients. Multiple regression including age demonstrated that Raynaud's disease severity could predict a reduction in PCS beyond that predicted by TDS. Raynaud's disease severity and duration of lcSSc were linked to low MCS. Arthritis reduced PCS and esophageal involvement reduced PCS and MCS. CONCLUSION: Physical health status of patients with lcSSc was reduced, with 30% of the variation predicted by TDS, age, and severity of Raynaud's disease VAS. Mental health status was not reduced in this population.