Antenatal Corticosteroids and Preterm Neonatal Morbidity and Mortality among Women with and without Diabetes in Pregnancy
Year: 2020
Type: article
Abstract: Objective The objective of this study was to determine whether antenatal corticosteroid exposure has a differential association with preterm neonatal morbidity among women with and without diabetes. Study Design Secondary analysis of an observational cohort of 115,502 women and their neonates born in 25 U.S. hospitals (2008–2011). Women who delivered at 230/7 to 336/7 weeks' gestation and received antenatal corticosteroids were compared with those who did not receive antenatal corticosteroids. Women with a stillbirth and women who delivered a neonate that was not resuscitated were excluded. The primary outcome was neonatal respiratory distress syndrome or death within 48 hours. Secondary outcomes included composite neonatal morbidity (respiratory distress syndrome, necrotizing enterocolitis, grades 3–4 intraventricular hemorrhage, sepsis, or death) and mechanical ventilation. Multivariable modified Poisson regression was used to estimate the association between antenatal corticosteroid exposure and neonatal outcomes. Maternal diabetes (pregestational and gestational) was evaluated as a potential effect modifier, and sensitivity analyses were conducted to evaluate whether receipt of a partial, single, or multiple course(s) of antenatal corticosteroids influenced results. Results A total of 4,429 women with 5,259 neonates met inclusion criteria: 3,716 (83.9%) women received antenatal corticosteroids and 713 (16.1%) did not. Of the 510 diabetic women (181 pregestational and 329 gestational), 439 (86.1%) received antenatal corticosteroids. Of the 3,919 nondiabetic women, 3,277 (83.6%) received antenatal corticosteroids. Antenatal corticosteroid exposure was not associated with respiratory distress syndrome or early death (adjusted relative risk [aRR] = 0.94, 95% confidence interval [CI]: 0.85–1.04), composite neonatal morbidity (aRR = 0.98, 95% CI: 0.89–1.07), or mechanical ventilation (aRR = 0.95, 95% CI: 0.86–1.05). There was no significant effect modification of maternal diabetes on the relationship between antenatal corticosteroids and neonatal outcomes (p > 0.05), and outcomes were similar in sensitivity analyses of partial, single, or multiple courses of corticosteroids. Discussion Antenatal corticosteroid administered to reduce preterm neonatal morbidity does not appear to have a differential association among women with diabetes compared with those without. Key Points
Source: American Journal of Perinatology
Authors: Ashley N. Battarbee, Grecio Sandoval, William A. Grobman, Jennifer L. Bailit, Uma M. Reddy, Ronald J. Wapner, Michael W. Varner, Steve N. Caritis, Mona Prasad, Alan T.N. Tita, George R. Saade, Yoram Sorokin, Dwight J. Rouse, Jorge E. Tolosa, for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network
Institutions: University of North Carolina at Chapel Hill, George Washington University, Northwestern University, MetroHealth, MetroHealth Medical Center, Case Western Reserve University, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Columbia University, University of Utah, University of Utah Health Care, University of Pittsburgh, The Ohio State University, University of Alabama at Birmingham, The University of Texas Medical Branch at Galveston, Wayne State University, Brown University, Oregon Health & Science University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1216570417, G1648937940, Maternal Fetal Medicine Network: Data Coordinating Cent*, G1882602020, Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network, Maternal Fetal Medicine Units Network, G2254024324, Case Western Reserve University/Cleveland Clinic CTSA (UL1), NICHD Maternal Fetal Medicine Units Network, G2594613454, NICHD Maternal-Fetal Medicine Units (MFMU) Network, G284963502, G29782494, Maternal-Fetal Medicine Units Network, NICHD Maternal Fetal Medicine Units Network, Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network, Cooperative Multicenter Maternal Fetal Medicine Units Networks, G3786447104, University of Utah Center for Clinical and Translational Science-UL1, G4027080872, G4238721334, Co-Operative Multicenter Trials in Obstetrics & Maternal Fetal Medicine, Data Coord Ctr-NICHD Cooperative Multicenter Maternal Medicine Units Research Net, Multicenter Network of Maternal Fetal Medicine Units, G4657398957, G50908112, Maternal Fetal Medicine Units Network, Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network (U10), G6657596466, G673807916, Brown/WIH Eunice Kennedy Shriver NICHD MFM Units Network Site, Maternal Fetal Medicine Network, NICHD Maternal Fetal Medicine Units Network, NICHD Materal Fetal Medicine Units Network, Clinical and Translational Science Collaborative of Cleveland, UofU Maternal-Fetal Medicine Units (MFMU) Network: Clinical Centers, NICHD Maternal-Fetal Medicine Units (MFMU) Network: Data CoordinatingCenter, Brown University/Women & Infants Hospital of Rhode Island (WIH) Center Application for the Eunice Kennedy Shriver NICHD Maternal Fetal Medicine Units Network, Maternal Fetal Medicine Units Network - Northwestern Study Center, Maternal-Fetal Medicine Units (MFMU) Network, Yale Clinical and Translational Science Award, Case Western Reserve University Center of the NICHD MFMU Network, Columbia University Maternal-Fetal Medicine Units Network Clinical Center, UAB Diabetes Research Center, NICHD maternal fetal medicine units network, UNC MFMU: Advancing Perinatal Health via Definitive, Multi-Site Clinical Studies, Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units (MFMU) Network (UG1), G922324195
OpenAlex ID: W3045852252