The Effect of Glucocorticoid Therapy on Fetal Lung Maturity Indices in Hypertensive Pregnancies JUAN J.PIAZZE,MD, LUCA MARANGHI, MD, GIOVANNI NIGRO, MD, GIUSEPPE RIZZO, MD, ERMELANDO V. COSMI,MD, AND MAURIZIO M.ANCESCHI, MD Objective: To assess fetal lung maturity tests in hypertensive pregnancies and to examine the effect of glucocorticoid therapy. Methods: In a cohort study involving 68 pregnant women with hypertension, 34 received antenatal betamethasone before amniocentesis and 34 did not.Controlswere 68 women with uncomplicated pregnancies, matched for gesta- tional age at amniocentesis and fetal gender. Amniotic fluid (AF) samples were analyzed by lamellar body count, plani- metric and stechiometric lecithin-sphingomyelin ratio (L/S), and presence of phosphatidylglycerol. Results: Fetallung maturity, as determined by lamellar body counts and by planimetric L/S, was lower in hyperten- sive pregnancies not treated with steroids than in controls (19,600 666 14,500 versus 39,800 666 22,700, P <<< .009, and 1.9 6 66 0.6 versus 3.9 6 66 1.8, P < << .01, respectively). In the period of 24 to 33 weeks’ gestation, the percentage of untreated pregnan- cies with mature lamellar body counts and mature L/S was significantly lower than that of controls (13% versus 33%, P << .001; 6% versus 40%, P <<< .002 and P < << .003, respectively). In contrast, in patientstreated with betamethasone, the percentage of cases with mature indices for both tests was not significantly different from thatof controls, but was higher than that of untreated hypertensive patients (40% versus 13%, P < << .001; 33% versus 6%, P < << .001). Phosphati- dylglycerol did not differamong groups. From 34 to 38 weeks, no difference was found in the percentage of mature cases for lamellar bodies in pregnant women with hyperten- sion not treated with steroids in comparison with controls (68% versus 84%), nor between cases treated and controls (74% versus 84%). In the same period, no difference in L/S values was found among groups, and the percentage of cases positive for phosphatidylglycerol was lower in hypertensive pregnancies than in controls (47% versus 95%, P < << .001) and was not affected by steroid treatment (37% versus 95%, P < << .001). Conclusion: Fetal lung maturity, as reflected in AF tests, is delayed in hypertensive pregnant patients, and steroids increase all lung maturity indices except phosphatidylglyc- erol between 24 and 33 weeks’ gestation. (Obstet Gynecol 1998;92:220 –5. © 1998 by The American College of Obste- tricians and Gynecologists.) The effect of hypertension in pregnancy on fetal lung maturity is highly controversial. Some reports 1 have described a decreased incidence of respiratory distress syndrome (RDS) among infants delivered from hyper- tensive mothers, suggesting an exposure to a higher endogenous production of glucocorticoids by the fetus, whereas others failed to confirm this finding, reporting a similar or even higher incidence of RDS. 2 The benefits of steroid administration for accelerating fetal lung maturity in pregnancies affected by hyperten- sion have been debated since Liggins and Howie 3 in 1972 cautioned against the use of prophylactic steroid therapy for the prevention of RDS. In 1994, the Consen- sus Conference ofthe NationalInstitutes ofHealth 4 stated thatpregnancy-induced hypertension is not a contraindication to glucocorticoid administration for induction of fetal lung maturation. The aim of this study was to examine whether lung maturity evidenced by amniotic fluid (AF) biochem- ical and biophysical markers is affected in pregnancy complicated by hypertension and whethersteroids are beneficialin promoting maturation ofthe fetal lung. From the 2nd Institute of Gynecology and Obstetrics, “La Sapienza” University, Rome,Italy;the Instituteof Pediatrics, “La Sapienza” University, Rome,Italy;and the Department of Obstetrics and Gyne- cology, “Tor Vergata” University, Rome, Italy. The Italian Research Council provided financial support for this work. 220 0029-7844/98/$19.00 Obstetrics & Gynecology PII S0029-7844(98)00169-0