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Am J Perinatol 2022; 39(01): 067-074
DOI: 10.1055/s-0040-1714391
Original Article

Antenatal Corticosteroids and Preterm Neonatal Morbidity and Mortality among Women with and without Diabetes in Pregnancy

Ashley N. Battarbee 
1   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Grecio Sandoval
2   George Washington University Biostatistics Center, Washington, District of Columbia
,
William A. Grobman
3   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Jennifer L. Bailit
4   Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
,
Uma M. Reddy
5   Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Ronald J. Wapner
6   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Michael W. Varner
7   Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
Steve N. Caritis
8   Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Mona Prasad
9   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Alan T.N. Tita
10   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
George R. Saade
11   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Yoram Sorokin
12   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
Dwight J. Rouse
13   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Jorge E. Tolosa
14   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network › Author Affiliations Funding This work was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, and HD53118; the National Center for Research Resources: UL1 RR024989 and 5UL1 RR025764. Comments and views of the authors do not necessarily represent views of the National Institutes of Health.
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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

  • Antenatal corticosteroids are used ubiquitously in women with and without diabetes.

  • Maternal diabetes does not appear to modify the neonatal effect of antenatal corticosteroids.

  • Larger studies of antenatal corticosteroids are needed to confirm our findings in diabetic women.

Keywords

corticosteroids - diabetes - preterm birth - respiratory distress syndrome

Note

This work was presented in poster format at the 39th annual meeting of the Society for Maternal-Fetal Medicine, Las Vegas, NV, February 11–16, 2019.


* See [Supplementary Material] (available in the online version) for a list of other members of the NICHD MFMU Network.


Supplementary Material



Publication History

Received: 06 January 2020

Accepted: 15 June 2020

Article published online:
27 July 2020

© 2020. Thieme. All rights reserved.

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