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Association of antenatal steroids with neonatal mortality and morbidity in preterm infants born to mothers with diabetes mellitus and hypertension

Journal of Perinatology volume 41, pages 1660–1668 (2021)Cite this article

Subjects

Abstract

Background

Randomized trials of antenatal steroids (ANS) included women at 24–33 weeks gestational age (GA); however, few women had preeclampsia and women with diabetes mellitus (DM) were excluded.

Methods

Cohort study including preterm births at 230/7–286/7 weeks GA before (Epoch-1) and after (Epoch-2) expansion of ANS administration to women with DM and hypertensive disorders (HTN). We compared Group-A (neither DM nor HTN) and Group-B (DM and/or HTN).

Results

Among 747 neonates the adjusted odds ratio (aOR) for surfactant administration, in-hospital mortality, severe intraventricular hemorrhage (IVH) and death or severe IVH were lower in ANS-exposed neonates than unexposed neonates. In Group-B, ANS administration was independently associated with less severe IVH and less death or severe IVH, but not less surfactant use or mortality.

Conclusions

Increased ANS administration in women with DM and/or HTN was independently associated with less severe IVH and less death or severe IVH but without decrease in surfactant administration.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Dr Bloom, Dr Leveno, Dr McIntire, Dr Pérez-Fontán and Dr Savani for participating in the discussions that eventually led to expansion of ANS to mothers with DM and HTN on 9/21/2015. Preliminary results were presented at the following meetings:

1. HMW, MAJ, MF, LPB. Parkland QI Bundle: Reducing Mortality and Morbidity in Extremely Low Gestational Age Neonates (ELGANs) at Parkland. Poster presentation at AAP National Conference and Exhibition, Washington DC, 10/23/2015.

2. HMW, MAJ, MSF, PJB, LPB. A Quality Improvement (QI) Project to Reduce Severe Intraventricular Hemorrhage (IVH). Poster at Pediatric Academy Societies Meeting, Toronto, Canada, 5/5/2018

3. HMW, MAJ, MSF, PJB, LPB. Interaction between Prophylactic Indomethacin (PIndo) and Antenatal Steroids (ANS) leading to Spontaneous Intestinal Perforation (SIP). Poster at Pediatric Academy Societies Meeting, Toronto, Canada, 5/7/2018.

Funding

No external funding for this paper.

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Heather M. Weydig, Charles R. Rosenfeld, Mambarambath A. Jaleel, Patti J. Burchfield, Mackenzie S. Frost & Luc P. Brion

  2. Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Mackenzie S. Frost

Authors
  1. Heather M. Weydig
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  2. Charles R. Rosenfeld
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  3. Mambarambath A. Jaleel
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  4. Patti J. Burchfield
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  5. Mackenzie S. Frost
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  6. Luc P. Brion
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Contributions

Dr HMW conceptualized and designed the study, collected data, coordinated and supervised data collection, carried out initial analyses, drafted the initial paper, and reviewed and revised the paper. Drs MAJ, CRR, MSF and LPB conceptualized and designed the study and reviewed and revised the paper. Ms PJB collected data and reviewed and revised the paper. Dr LPB carried out the analyses. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Luc P. Brion.

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Weydig, H.M., Rosenfeld, C.R., Jaleel, M.A. et al. Association of antenatal steroids with neonatal mortality and morbidity in preterm infants born to mothers with diabetes mellitus and hypertension. J Perinatol 41, 1660–1668 (2021). https://doi.org/10.1038/s41372-021-01090-x

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