Latency of late preterm steroid administration to delivery and risk of neonatal hypoglycemia

McElwee, Eliza R.; Wilkinson, Kyla; Crowe, Rebecca; Hardy, Karen; Newman, Ms Jill C; Chapman, Alison; Finneran, Matthew M.

doi:10.1016/j.ajogmf.2022.100687

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…Of 5 950 223 recorded live births at ≥34 weeks' gestation in England and Wales 2012-2020 (ONS), 420 866 infants (7.1% of all livebirths, 95% CI 7.1-7.1) meeting study inclusion criteria had an NNRD record of NNU admission (Figure S1). A maternal HDP was recorded in 30 944/420 866 of admitted infants (7.4%, 95% CI 7.3-7.4), with a higher burden in late preterm infants (16 1A). Gestational hypertension was the most common recorded maternal HDP overall (Figure S1).…”

Section: Burden Of Hdp On Nnu Admissionsmentioning

confidence: 99%

“…In comparison with infants born to normotensive mothers, infants born to mothers with hypertensive disorders of pregnancy (HDP) have a higher risk of preterm birth, 5,8 with concomitant risks of prematurity including respiratory morbidity 9 . HDP infants also have a higher risk of hypoglycaemia as a result of fetal growth restriction secondary to poor placental function and iatrogenic causes secondary to maternal antenatal antihypertensive agent use (although evidence of the neonatal effects of in utero antihypertensive agent exposure remains sparse and conflicting), 10–14 and antenatal corticosteroid use in preterm birth 15–17 . Whereas antenatal corticosteroid use to reduce respiratory morbidity in preterm infants is well established, 18 strategies to reduce infant hypoglycaemia in the context of HDP are lacking.…”

Section: Introductionmentioning

confidence: 99%

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The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012–2020 and opportunities to avoid admission: A population‐based study using the National Neonatal Research Database

Conti‐Ramsden

Fleminger

Lanoue

et al. 2023

BJOG

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ObjectiveTo quantify maternal hypertensive disorder of pregnancy (HDP) prevalence in late preterm and term infants admitted to neonatal units (NNU) and assess opportunities to avoid admissions.DesignA retrospective population‐based study using the National Neonatal Research Database.SettingEngland and Wales.PopulationInfants born ≥34 weeks’ gestation admitted to NNU between 2012 and 2020.MethodsOutcomes in HDP infants are compared with non‐HDP infants using regression models.Main outcome measuresHypertensive disorder of pregnancy, primary reason for admission, clinical diagnoses and resource use.Results16 059/136 220 (11.8%) of late preterm (34+0 to 36+6 weeks’ gestation) and 14 885/284 646 (5.2%) of term (≥37 weeks’ gestation) admitted infants were exposed to maternal HDP. The most common primary reasons for HDP infant admission were respiratory disease (28.3%), prematurity (22.7%) and hypoglycaemia (16.4%). HDP infants were more likely to be admitted with primary hypoglycaemia than were non‐HDP infants (odds ratio [OR] 2.1, 95% confidence interval [CI] 2.0–2.2, P < 0.0001). 64.5% of HDP infants received i.v. dextrose. 35.7% received mechanical or non‐invasive ventilation. 8260/30 944 (26.7%) of HDP infants received intervention for hypoglycaemia alone (i.v. dextrose) with no other major intervention (respiratory support, parenteral nutrition, central line, arterial line or blood transfusion).ConclusionsThe burden of maternal HDP on late preterm and term admissions to NNU is high, with hypoglycaemia and respiratory disease being the main drivers for admission. Over one in four were admitted solely for management of hypoglycaemia. Further research should determine whether maternal antihypertensive agent choice or postnatal pathways may reduce NNU admission.

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Section: Burden Of Hdp On Nnu Admissionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012–2020 and opportunities to avoid admission: A population‐based study using the National Neonatal Research Database

Conti‐Ramsden

Fleminger

Lanoue

et al. 2023

BJOG

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Antenatal corticosteroids: an updated assessment of anticipated benefits and potential risks

Jobe,

Goldenberg,

Kemp

2024

American Journal of Obstetrics and Gynecology

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Late preterm antenatal corticosteroids in singleton and twin gestations: a retrospective cohort study

Vieira

Kao

Tsevdos

et al. 2022

BMC Pregnancy Childbirth

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Background In 2016, the American College of Obstetricians and Gynecologists recommended antenatal corticosteroids in the late preterm period for women at risk for preterm delivery. Limited real-world evidence exists on neonatal outcomes, particularly for twin gestations, following the guideline change. The study objective is to determine the association of antenatal corticosteroids in late preterm singleton and twin pregnancies with respiratory complications and hypoglycemia in a real-world clinical setting. Methods This is a retrospective cohort study comprising late preterm deliveries (4,341 mother–child pairs) within the Mount Sinai Health System, 2012–2018. The exposure of interest is antenatal corticosteroid administration of betamethasone during pregnancy between 34 0/7 and 36 6/7 weeks. Our primary outcomes are neonatal respiratory complications and hypoglycemia. Multivariable logistic regression was used to estimate the association between antenatal corticosteroid exposure and these two outcomes. We stratified the study population by singleton gestations and twins to minimize the potential confounding from different obstetric management between the two groups. Results Among a total of 4,341 mother–child pairs (3,309 singleton and 1,032 twin mother–child pairs), 745 mothers received betamethasone, of which 40.94% (305/745) received the full course. Relative to no treatment, a full course of betamethasone was associated with reduced odds of respiratory complications (OR = 0.53, 95% CI:[0.31–0.85], p < 0.01) and increased odds of hypoglycemia (OR = 1.86, 95%CI:[1.34–2.56], p < 0.01) in singletons; however, the association with respiratory complications was not significant in twins (OR = 0.42, 95% CI:[0.11–1.23], p = 0.16), but was associated with increased odds of hypoglycemia (OR = 2.18, 95% CI:[1.12–4.10], p = 0.02). A partial course of betamethasone (relative to no treatment) was not significantly associated with any of the outcomes, other than respiratory complications in twins (OR = 0.34, 95% CI:[0.12–0.82], p = 0.02). Conclusions Exposure to antenatal corticosteroids in singletons and twins is associated with increased odds of hypoglycemia. Among singletons, exposure to the full dosage (i.e. two doses) was associated with decreased odds of respiratory complications but this was only the case for partial dose among twins. Twin gestations were not studied by the Antenatal Late Preterm Steroids trial. Therefore, our study findings will contribute to the paucity of evidence on the benefit of antenatal corticosteroids in this group. Health systems should systematically monitor guideline implementations to improve patient outcomes.

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Latency of late preterm steroid administration to delivery and risk of neonatal hypoglycemia

Cited by 3 publications

References 26 publications

The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012–2020 and opportunities to avoid admission: A population‐based study using the National Neonatal Research Database

The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012–2020 and opportunities to avoid admission: A population‐based study using the National Neonatal Research Database

Antenatal corticosteroids: an updated assessment of anticipated benefits and potential risks

Late preterm antenatal corticosteroids in singleton and twin gestations: a retrospective cohort study

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