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

Abstract

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.

Management of late‐onset fetal growth restriction: pragmatic approach

“…The TRUFFLE group reported the outcome of more than 800 pregnancies with late preterm FGR 39 . The rate of severe adverse neonatal outcome (11%) was higher compared with that in our study.…”

“…Severe respiratory morbidity included respiratory support for more than 1 week, mechanical ventilation, meconium aspiration and persistent pulmonary hypertension of the newborn. Severe circulatory morbidity included hypotensive treatment or ductus arteriosus treatment and disseminated intravascular coagulation 3,39 .…”

“…Based on previous pilot and observational data 3,39,42 , we calculated that, in order to detect a significant reduction in composite adverse neonatal outcome of more than 15% between the low-and high-risk groups, a sample size of 152 women per group would be required (alpha 0.05; power 80%).…”

Development of a deep learning-based grading model to evaluate fetal lung maturity from normal fetal lung ultrasound images

“…In addition, the evidence that the use of glucocorticoids can bene t from the elements that increase the risk of adverse pregnancy outcomes of pregnant women is still uncertain, and even has adverse effects on fetal growth. [20] Therefore, ultrasound quantitative analysis shows that the use of glucocorticoids can be reduced or even avoided when the fetal lung is mature. We hope that our model can help to apply the extracted data information to the clinical decision support system, so as to improve the accuracy of disease prediction and diagnosis and obtain better prognosis.…”

Respiratory morbidity among offspring misclassified as growth restricted

“…Inevitably, some fetuses that are suspected to be growth‐restricted are later found, at the time of birth, to be appropriately grown (appropriate for gestational age [AGA] birth weight, between the 10th and 90th percentile). These fetuses may have been subjected to unnecessary medical interventions like antenatal corticosteroid administration, 20 iatrogenic preterm labor, 21 and a higher rate of cesarean delivery (CD), 22 all of which have the potential to impact their health.…”