Antenatal corticosteroids in the late preterm period for growth-restricted pregnancies

Bitar, Ghamar; Merrill, Scott J.; Sciscione, Anthony; Hoffman, Matthew

doi:10.1016/j.ajogmf.2020.100153

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Therefore, obstetricians must base clinical practice on observational studies only. The present data on short-term outcome are in line with several papers showing no significant beneficial effect of steroid administration in the context of FGR 5,13,14,19 . Only one of these studies targeted late preterm FGR 19 , similar to ours, and did not observe a decrease in respiratory morbidity following ACS administration.…”

Section: Discussionsupporting

confidence: 92%

“…The present data on short-term outcome are in line with several papers showing no significant beneficial effect of steroid administration in the context of FGR 5,13,14,19 . Only one of these studies targeted late preterm FGR 19 , similar to ours, and did not observe a decrease in respiratory morbidity following ACS administration. However, other studies on early preterm neonates and those born with FGR observed a reduction in cerebral hemorrhage 22 , a reduced risk of RDS, intraventricular hemorrhage and perinatal death 12 or an increase in survival without disability or impairment at 2 years of age 23 following ACS administration.…”

Section: Discussionsupporting

confidence: 92%

“…The present data do not show a beneficial effect of ACS on short‐term outcome in a prospectively selected and appropriately FGR phenotyped cohort. The small sample size and the fact that no matched control could be found for the 11 women with the highest risk represent limitations of the study given the possibility that a type‐II error may still be present, and do not allow definitive conclusions to be drawn regarding the benefit or disadvantages of steroids in FGR 19 . An adequately powered study to explore significantly and clinically meaningful differences in reducing composite adverse outcome from 21% to 10% would require 225 women per intervention arm (90% power, alpha 0.05 and beta 0.1).…”

Section: Discussionmentioning

confidence: 99%

“…It has also been demonstrated that repeated administration of steroids to mothers at risk of preterm birth can adversely affect fetal growth, induce hypertension and reduce brain growth with delayed myelination 5 , 15 . A retrospective study of 247 pregnancies with FGR or small‐for‐gestational‐age fetuses found that ACS in the late preterm period did not decrease significantly the need for respiratory support in newborns, while the rate of neonatal hypoglycemia increased significantly after ACS exposure 19 . However, following the results of the Antenatal Late Preterm Steroids (ALPS) trial 27 , the American College of Obstetricians and Gynecologists and the Society of Maternal–Fetal Medicine recommended steroid administration for late preterm pregnancies without prior exposure to ACS and at risk of delivery within the next 7 days 28 .…”

Section: Discussionmentioning

confidence: 99%

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Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort

Familiari

Napolitano

Visser

et al. 2023

Ultrasound in Obstet & Gyne

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Objective To evaluate the role of antenatal administration of corticosteroids for fetal lung maturation on the short‐term perinatal outcome of pregnancy complicated by late fetal growth restriction (FGR). Methods This cohort study was a secondary analysis of a multicenter prospective observational study, the TRUFFLE‐2 feasibility study, conducted between 2017 and 2018 in 33 European perinatal centers. The study included women with a singleton pregnancy from 32 + 0 to 36 + 6 weeks of gestation with a fetus considered at risk for FGR, defined as estimated fetal weight (EFW) and/or fetal abdominal circumference < 10th percentile, or umbilicocerebral ratio (UCR) ≥ 95th percentile or a drop of more than 40 percentile points in abdominal circumference measurement from the 20‐week scan. For the purposes of the current study, we identified women who received a single course of steroids to improve fetal lung maturation before delivery. Each exposed pregnancy was matched with one that did not receive antenatal corticosteroids (ACS) (control), based on gestational age at delivery and birth weight. The primary adverse outcome was a composite of abnormal condition at birth, major neonatal morbidity or perinatal death. Results A total of 86 pregnancies that received ACS were matched to 86 controls. The two groups were similar with respect to gestational age (33.1 vs 33.3 weeks), EFW (1673 vs 1634 g) and UCR (0.68 vs 0.62) at inclusion, and gestational age at delivery (35.5 vs 35.9 weeks) and birth weight (1925 vs 1948 g). No significant differences were observed between the exposed and non‐exposed groups in the incidence of composite adverse outcome (28% vs 24%; P = 0.73) or any of its elements. Conclusion The present data do not show a beneficial effect of steroids on short‐term outcome of fetuses with late FGR. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort

Familiari

Napolitano

Visser

et al. 2023

Ultrasound in Obstet & Gyne

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Neonatal hypoglycemia following antenatal corticosteroid treatment prior to elective cesarean delivery during the early term period: a meta-analysis

Pergialiotis¹,

Rodolaki²,

Nikolakea³

et al. 2023

AJOG Global Reports

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Antenatal corticosteroids in specific groups at risk of preterm birth: a systematic review

Saito,

Nishimura,

Ota

et al. 2023

BMJ Open

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ObjectiveThis study aimed to synthesise available evidence on the efficacy of antenatal corticosteroid (ACS) therapy among women at risk of imminent preterm birth with pregestational/gestational diabetes, chorioamnionitis or fetal growth restriction (FGR), or planned caesarean section (CS) in the late preterm period.MethodsA systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science and Global Index Medicus was conducted for all comparative randomised or non-randomised interventional studies in the four subpopulations on 6 June 2021. Risk of Bias Assessment tool for Non-randomised Studies and the Cochrane Risk of Bias tool were used to assess the risk of bias. Grading of Recommendations Assessment, Development and Evaluations tool assessed the certainty of evidence.ResultsThirty-two studies involving 5018 pregnant women and 10 819 neonates were included. Data on women with diabetes were limited, and evidence on women undergoing planned CS was inconclusive. ACS use was associated with possibly reduced odds of neonatal death (pooled OR: 0.51; 95% CI: 0.31 to 0.85, low certainty), intraventricular haemorrhage (pooled OR: 0.41; 95% CI: 0.23 to 0.72, low certainty) and respiratory distress syndrome (pooled OR: 0.59; 95% CI: 0.45 to 0.77, low certainty) in women with chorioamnionitis. Among women with FGR, the rates of surfactant use (pooled OR: 0.38; 95% CI: 0.23 to 0.62, moderate certainty), mechanical ventilation (pooled OR: 0.42; 95% CI: 0.26 to 0.66, moderate certainty) and oxygen therapy (pooled OR: 0.48; 95% CI: 0.30 to 0.77, moderate certainty) were probably reduced; however, the rate of hypoglycaemia probably increased (pooled OR: 2.06; 95% CI: 1.27 to 3.32, moderate certainty).ConclusionsThere is a paucity of evidence on ACS for women who have diabetes. ACS therapy may have benefits in women with chorioamnionitis and is probably beneficial in FGR. There is limited direct trial evidence on ACS efficacy in women undergoing planned CS in the late preterm period, though the totality of evidence suggests it is probably beneficial.PROSPERO registration numberCRD42021267816.

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Antenatal corticosteroids in the late preterm period for growth-restricted pregnancies

Cited by 4 publications

References 8 publications

Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort

Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort

Neonatal hypoglycemia following antenatal corticosteroid treatment prior to elective cesarean delivery during the early term period: a meta-analysis

Antenatal corticosteroids in specific groups at risk of preterm birth: a systematic review

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