OBJECTIVE: To evaluate whether neonates born to women who previously had received antenatal corticosteroids and then delivered a late-preterm-birth neonate had less respiratory morbidity compared with those not exposed to antenatal corticosteroids.
METHODS: This is a secondary analysis from a multicenter observational study regarding mode of delivery after previous cesarean delivery. We compared women who received one course of antenatal corticosteroids with unexposed parturients and evaluated various respiratory outcomes among those having a singleton, late-preterm-birth neonate. We controlled for potential confounders including gestational age at delivery, diabetes, mode of delivery, and maternal race.
RESULTS: Five thousand nine hundred twenty-four patients met the inclusion criteria; 550 received steroids and 5,374 did not. In the univariable model, compared with unexposed women, those who received antenatal corticosteroids appeared more likely to have neonates who required ventilatory support (11.5% compared with 8.6%, P=.022), had respiratory distress syndrome (RDS) (17.1% compared with 12.2%, P=.001), developed transient tachypnea of the newborn (12.9% compared with 9.8%, P=.020), or required resuscitation in the delivery room (55.8% compared with 49.7%, P=.007). After controlling for confounding factors, we found no significant differences among the groups regarding all of the above outcomes with an odds ratio for RDS of 0.78 (95% confidence interval, 0.60–1.02) and ventilator support of 0.75 (95% confidence interval, 0.55–1.03).
CONCLUSION: Exposure to antenatal corticosteroids does not significantly affect respiratory outcomes among those with a subsequent late-preterm birth.
LEVEL OF EVIDENCE: II
In our cohort, antenatal corticosteroid exposure does not influence respiratory outcomes when birth occurs during the late-preterm period.
From the Departments of Obstetrics and Gynecology, Columbia University, New York, New York, The Ohio State University, Columbus, Ohio, the University of Alabama at Birmingham, Birmingham, Alabama, the University of Utah, Salt Lake City, Utah, Wake Forest University Health Sciences, Winston-Salem, North Carolina, Thomas Jefferson University, Philadelphia, Pennsylvania, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, Northwestern University, Chicago, Illinois, the University of Miami, Miami, Florida, the University of Tennessee, Memphis, Tennessee, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, the University of Texas Health Science Center, Houston, Houston, Texas, Case Western Reserve University-MetroHealth Medical, Cleveland, Ohio, the George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
* For a list of other members of the NICHD MFMU, see the Appendix online at http://links.lww.com/AOG/A285.
Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) (HD21410, HD21414, HD27860, HD27861, HD27869, HD27905, HD27915, HD27917, HD34116, HD34122, HD34136, HD34208, HD34210, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, and HD36801) and its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NICHD or of the NIH.
The authors thank Francee Johnson, RN, BSN, for protocol development and coordination between clinical research centers; Elizabeth Thom, PhD, for protocol and data management and statistical analysis; and Ronald J. Wapner, MD, and John C. Hauth, MD, for protocol development and oversight.
Presented at the Society for Gynecologic Investigation, March 17–21, 2009, Glasgow, Scotland.
Dr. Spong, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.
Corresponding author: Cynthia Gyamfi, MD, Columbia University Medical Center, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 622 West 168th Street, PH-16, New York, NY 10032; e-mail: firstname.lastname@example.org.
Financial Disclosure The authors did not report any potential conflicts of interest.