Association of antenatal steroids with surfactant administration in moderate preterm infants born to women with diabetes mellitus and/or hypertension

Weydig, Heather M.; Rosenfeld, Charles R.; Wyckoff, Myra H.; Jaleel, Mambarambath A.; Burchfield, Patti J.; Thomas, Anita; Frost, Mackenzie S.; Brion, Luc P.

doi:10.1038/s41372-021-01273-6

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…The bene cial impact of ACS exposure among very preterm infants whose mothers had HDP was evident with a 40% reduction in the need for surfactant and/or IMV in our study. This nding was consistent with data from various cohorts, including a national population-based cohort from Japan (11), a provincial population-based cohort from Canada(8), a cohort from USA (13), and ndings from two trials(6, 7). Our study reinforces these observations through thorough adjustments, multiple subgroup analyses, and sensitivity analyses, lending strong support to the current practice of prescribing ACS to pregnant women with HDP at risk of preterm birth.…”

Section: Discussionsupporting

confidence: 87%

“…While ACS has been widely used to infants born to mothers with HDP, the existing literature on its e cacy and safety in these speci c cases remains limited and contradictory (2). Previous studies, including several randomised clinical trials (4,5,6,7) and cohort studies(8, 9,10,11,12,13) have been hindered by small sample sizes, inadequate control for confounders such as gestational age (GA), a focus on severe cases of maternal HDP, lack of subgroup analysis based on the severity of HDP and courses of ACS. These limitations have led to a lack of reliable clinical recommendations and raised concerns about the safety of ACS in HDP-affected pregnancies, particularly in the context of altered uterine perfusion and systemic changes like hypoxia and oxidative stress (14).…”

Section: Introductionmentioning

confidence: 99%

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Association between Antenatal Corticosteroids and Neonatal Outcomes among Very Preterm Infants Born to Mothers with Hypertensive Disorders of Pregnancy: A Multicenter Cohort Study

Sun,

Qian,

et al. 2024

Preprint

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Background The relationship between antenatal corticosteroids (ACS) and preterm infants born to mothers with hypertensive disorders of pregnancy (HDP) remains a subject of debate. To evaluate whether the use of ACS before delivery was associated with neonatal outcomes in very preterm infants born to mothers with HDP. Methods This multicenter cohort study enrolled all infants with gestational age at 24 to 31 week and admitted to tertiary NICUs of the Chinese Neonatal Network (CHNN) within 24 hours of birth from 2019 to 2021. ACS administration was defined as at least one dose of dexamethasone or betamethasone before delivery. The primary outcome was surfactant and/ or invasive mechanical ventilation (IMV) within 72 hours of life. Multivariable logistic regression analyses were performed to assess the association between ACS and neonatal outcomes. Results Among the 4,582 study infants born to mothers with HDP, 3,806 (83.1%) were exposed to ACS. ACS treatment was significantly associated with lower risk of requirement of surfactant and/ or IMV within 72 hours of life (adjusted Odds Ratio = 0.60, 95% confidence interval 0.49–0.74). ACS exposure was also independently associated with decreased mortality, surfactant use, IMV, combined surfactant and IMV use and moderate or severe bronchopulmonary dysplasia. The severity of maternal HDP did not appear to influence the correlation between ACS treatment and neonatal outcomes. Our analysis also indicated that a single complete course seemed to have the most significant protective effect. Conclusions Our study reinforces the significant role of ACS in reducing severe respiratory morbidity and mortality in very preterm infants born to mothers with HDP.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Association between Antenatal Corticosteroids and Neonatal Outcomes among Very Preterm Infants Born to Mothers with Hypertensive Disorders of Pregnancy: A Multicenter Cohort Study

Sun,

Qian,

et al. 2024

Preprint

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“…A recent cohort study examined the association of antenatal steroids in the moderate preterm period (29 weeks 0 days–33 weeks 6 days) in patients with diabetes mellitus. This study noted that surfactant administration was not associated with steroid exposure in patients with PGDM, unlike other maternal conditions such as HDP 25 . Additional biochemical studies have examined and noted adverse development of fetal lungs with steroid exposure with regard to long‐term outcomes and chronic pulmonary disease 26 .…”

Section: Discussionmentioning

confidence: 82%

“…This study noted that surfactant administration was not associated with steroid exposure in patients with PGDM, unlike other maternal conditions such as HDP. 25 Additional biochemical studies have examined and noted adverse development of fetal lungs with steroid exposure with regard to long-term outcomes and chronic pulmonary disease. 26 findings, along with prior literature, highlight the importance of further studies examining the risk and benefit ratio of steroid administration, particularly in pregnancies complicated by PGDM.…”

Section: Discussionmentioning

confidence: 99%

Antenatal steroids and neonatal outcomes in late preterm births with pregestational diabetes

Khanuja,

Jayakumaran,

Al‐Kouatly

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo evaluate if antenatal steroid use was associated with a lower rate of respiratory complications in neonates born late preterm to patients with pregestational diabetes mellitus (PGDM).MethodsThis was a retrospective cohort study of live, singleton, non‐anomalous, late preterm births complicated by PGDM using data from the Centers for Disease Control and National Vital Statistics System from 2017 to 2021. The primary (assisted ventilation use >6 h) and secondary neonatal outcomes (immediate assisted ventilation, Apgar score, neonatal intensive care unit [NICU] admission, and surfactant use) were compared between births that received steroids and those that did not. Multivariable analyses were performed to adjust for differences in demographic and clinical characteristics.ResultsThere were 24 323 late preterm births with PGDM, of which 4613 received antenatal steroids and 19 710 did not receive steroids. After adjusting for the differences among the two groups, the need for assisted neonatal ventilation for more than 6 h (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.53–1.86), immediate assisted neonatal ventilation (aOR 1.67, 95% CI 1.55–1.80), NICU admission (aOR 1.95, 95% CI 1.81–2.10), and surfactant use (aOR 1.68, 95% CI 1.40–2.02) were higher in the births that received steroids compared with those that did not. These findings did not differ when examining outcomes at each gestational week of delivery between 34 weeks 0 days and 36 weeks 6 days.ConclusionsAntenatal steroid use in late preterm births complicated with PGDM was associated with worse immediate respiratory neonatal outcomes. Our findings support current recommendations against the use of steroids in the late preterm period in pregnancies with PGDM.

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Maternal and neonatal outcomes following antenatal corticosteroids in pregnancies complicated by diabetes: a scoping review

Atallah,

Moon,

Lee

et al. 2024

AJOG Global Reports

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Association of antenatal steroids with surfactant administration in moderate preterm infants born to women with diabetes mellitus and/or hypertension

Cited by 4 publications

References 33 publications

Association between Antenatal Corticosteroids and Neonatal Outcomes among Very Preterm Infants Born to Mothers with Hypertensive Disorders of Pregnancy: A Multicenter Cohort Study

Association between Antenatal Corticosteroids and Neonatal Outcomes among Very Preterm Infants Born to Mothers with Hypertensive Disorders of Pregnancy: A Multicenter Cohort Study

Antenatal steroids and neonatal outcomes in late preterm births with pregestational diabetes

Maternal and neonatal outcomes following antenatal corticosteroids in pregnancies complicated by diabetes: a scoping review

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