Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry

Haytham Ali; Husam Salama; Nicola Robertson; Tawa Olukade; Sawsan AL-Obaidly; Mai Al-Qubaisi; Hilal Al Rifai

doi:10.1515/jpm-2020-0249

Article

Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry

Haytham Ali , Husam Salama , Nicola Robertson , Tawa Olukade , Sawsan AL-Obaidly , Mai Al-Qubaisi and Hilal Al Rifai

Published/Copyright: October 26, 2020

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From the journal Journal of Perinatal Medicine Volume 49 Issue 3

Abstract

Objectives

A recent discussion surrounding the extension of antenatal corticosteroid (ACS) use beyond 34 weeks of gestation did not include the subgroup of infants of diabetic mothers (IDM). We aimed to examine the association between ACS exposure and outcomes in neonates born at term and at near-term gestation in a large cohort of IDMs.

Methods

We selected 13976 eligible near-term and term infants who were included in the PEARL-Peristat Perinatal Registry Study (PPS). We assessed the association of ACS exposure with neonatal outcomes in a multivariate regression model that controlled for diabetes mellitus (DM) and other perinatal variables.

Results

The incidence of DM was 28% (3,895 of 13,976) in the cohort. Caesarean section was performed in one-third of the study population. The incidence of ACS exposure was low (1.8%) and typically occurred>2 weeks before delivery. The incidence rates of respiratory distress syndrome (RDS)/ transient tachypnoea of newborns (TTN), all-cause neonatal intensive care unit (NICU) admissions, NICU admissions for hypoglycaemia, and low 5-min Apgar scores were 3.5, 8.8, 1.3, and 0.1%, respectively. In a multivariate regression model, ACS was associated with a slight increase in NICU admissions (OR: 1.44; 95% CI: 1.04–2.03; p=0.028), but not with RDS/TTN.

Conclusions

Although the low exposure rate was a limitation, ACS administration did not reduce respiratory morbidity in near-term or term IDMs. It was independently associated with an increase in NICU admissions. Randomized controlled trials are required to assess the efficacy and safety of ACS administration in diabetic mothers at late gestation.

Keywords: antenatal corticosteroids (ACS); diabetes mellitus (DM); infants of diabetic mothers (IDM); neonatal intensive care unit (NICU); respiratory distress syndrome (RDS); transient tachypnoea of newborns (TTN)

Corresponding author: Haytham Ali, Consultant Neonatologist, Assistant Professor of Pediatrics, Weill Cornell Medicine – Qatar, Sidra Medicine, PO BOX 26999 Doha, Qatar, E-mail: hali@sidra.org.

Research funding: The PPS is funded by the Qatar National Research Fund (Grant no NPRP 6-238-3-059) and is sponsored by the Medical Research Centre.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: The registry study was granted with an umbrella waver of consent for access and analysis of de-identified retrospective patient data.
Ethical approval: The Hamad Medical Corporation Institutional Review Board approved the study.

References

1. Fung, GP, Chan, LM, Ho, YC, To, WK, Chan, HB, Lao, TT. Does gestational diabetes mellitus affect respiratory outcome in late-preterm infants? Early Hum Dev 2014;90:527–30. https://doi.org/10.1016/j.earlhumdev.2014.04.006.Search in Google Scholar PubMed

2. Mortier, I, Blanc, J, Tosello, B, Gire, C, Bretelle, F, Carcopino, X. Is gestational diabetes an independent risk factor of neonatal severe respiratory distress syndrome after 34 weeks of gestation? A prospective study. Arch Gynecol Obstet 2017;296:1071–7. https://doi.org/10.1007/s00404-017-4505-7.Search in Google Scholar PubMed

3. Bashir, M, Abdel-Rahman, ME, Aboulfotouh, M, Eltaher, F, Omar, K, Babarinsa, I, et al. Prevalence of newly detected diabetes in pregnancy in Qatar, using universal screening. PLoS One 2018;13:e0201247. https://doi.org/10.1371/journal.pone.0201247.Search in Google Scholar PubMed PubMed Central

4. Soliman, A, Salama, H, Al Rifai, H, De Sanctis, V, Al-Obaidly, S, Al Qubasi, M, et al. The effect of different forms of dysglycemia during pregnancy on maternal and fetal outcomes in treated women and comparison with large cohort studies. Acta Biomed 2018;89:11–21. https://doi.org/10.23750/abm.v89iS4.7356.Search in Google Scholar PubMed PubMed Central

5. Azad, MB, Moyce, BL, Guillemette, L, Pascoe, CD, Wicklow, B, McGavock, JM, et al. Diabetes in pregnancy and lung health in offspring: developmental origins of respiratory disease. Paediatr Respir Rev 2017;21:19–26. https://doi.org/10.1016/j.prrv.2016.08.007.Search in Google Scholar PubMed

6. Roberts, D, Brown, J, Medley, N, Dalziel, SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017;3:CD004454. https://doi.org/10.1002/14651858.CD004454.pub3.Search in Google Scholar PubMed PubMed Central

7. KC, K, Shakya, S, Zhang, H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab 2015;66:14–20. https://doi.org/10.1159/000371628.Search in Google Scholar PubMed

8. Stubbs, WA, Stubbs, SM. Hyperinsulinism, diabetes mellitus, and respiratory distress of the newborn: a common link ? Lancet 1978;1:308–9. https://doi.org/10.1016/s0140-6736(78)90075-2.Search in Google Scholar PubMed

9. Ramachandrappa, A, Jain, L. Elective cesarean section: its impact on neonatal respiratory outcome. Clin Perinatol 2008;35:373–93. https://doi.org/10.1016/j.clp.2008.03.006.Search in Google Scholar PubMed PubMed Central

10. Jain, L, Eaton, DC. Physiology of fetal lung fluid clearance and the effect of labor. Semin Perinatol 2006;30:34–43. https://doi.org/10.1053/j.semperi.2006.01.006.Search in Google Scholar PubMed

11. Sotiriadis, A, Makrydimas, G, Papatheodorou, S, Ioannidis, JP, McGoldrick, E. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev 2018;8:CD006614. https://doi.org/10.1002/14651858.CD006614.pub3.Search in Google Scholar PubMed PubMed Central

12. Kamath-Rayne, BD, Rozance, PJ, Goldenberg, RL, Jobe, AH. Antenatal corticosteroids beyond 34 weeks gestation: what do we do now? Am J Obstet Gynecol 2016;215:423–30. https://doi.org/10.1016/j.ajog.2016.06.023.Search in Google Scholar PubMed

13. Saccone, G, Berghella, V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta‐analysis of randomized controlled trials. BMJ 2016;355:i5044. https://doi.org/10.1136/bmj.i5044.Search in Google Scholar PubMed PubMed Central

14. Amiya, RM, Mlunde, LB, Ota, E, Swa, T, Oladapo, OT, Mori, R. Antenatal corticosteroids for reducing adverse maternal and child outcomes in special populations of women at risk of imminent preterm birth: a systematic review and meta-analysis. PLoS ONE 2016;11:e0147604. https://doi.org/10.1371/journal.pone.0147604.Search in Google Scholar PubMed PubMed Central

15. Committee on Obstetric Practice. Committee Opinion No. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol 2017;130:e102–9.10.1097/AOG.0000000000002237Search in Google Scholar PubMed

16. National Institute for Health and Care Excellence (NICE). Surveillance report (exceptional review) 2017 – preterm labour and birth; 2015. NICE guideline [NG25]. 2017. Available from https://www.nice.org.uk/guidance/ng25 [Accessed 14th March 2020].Search in Google Scholar

17. Skoll, A, Boutin, A, Bujold, E, Burrows, J, Crane, J, Geary, M, et al. No. 364-Antenatal corticosteroid therapy for improving neonatal outcomes. J Obstet Gynaecol Can 2018;40:1219–39. https://doi.org/10.1016/j.jogc.2018.04.018.Search in Google Scholar PubMed

18. Gyamfi-Bannerman, C, Gilbert, S, Landon, MB, Spong, CY, Rouse, DJ, Varner, MW, et al. Eunice Kennedy Shriver National Institute of Child Health; Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Effect of antenatal corticosteroids on respiratory morbidity in singletons after late-preterm birth. Obstet Gynecol 2012;119:555–9. https://doi.org/10.1097/aog.0b013e31824758f6.Search in Google Scholar

19. Gyamfi‐Bannerman, C, Thom, EA, Blackwell, SC, Tita, AT, Reddy, UM, Saade, GR, et al. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016;374:1311–20. https://doi.org/10.1056/NEJMoa1516783.Search in Google Scholar PubMed PubMed Central

20. Krispin, E, Hochberg, A, Chen, R, Wiznitzer, A, Hadar, E, Borovich, A. Neonatal outcome in gestational-diabetic mothers treated with antenatal corticosteroids delivering at the late preterm and term. Arch Gynecol Obstet 2018;298:689–95. https://doi.org/10.1007/s00404-018-4848-8.Search in Google Scholar PubMed

21. Langen, ES, Kuperstock, JL, Sung, JF, Taslimi, M, Byrne, J, El-Sayed, YY. Maternal glucose response to betamethasone administration. Am J Perinatol 2015;30:143–8. https://doi.org/10.1055/s-0034-1376387.Search in Google Scholar PubMed

22. Lau, HCQ, Tung, JSZ, Wong, TTC, Tan, PL, Tagore, S. Timing of antenatal steroids exposure and its effects on neonates. Arch Gynecol Obstet 2017;296:1091–6. https://doi.org/10.1007/s00404-017-4543-1.Search in Google Scholar PubMed

23. Schmidt, AF, Kemp, MW, Rittenschober-Böhm, J, Kannan, PS, Usuda, H, Saito, M, et al. Low-dose betamethasone-acetate for the fetal lung maturation in preterm sheep. Am J Obstet Gynecol 2018;218:132. e1–9. https://doi.org/10.1016/j.ajog.2017.11.560.Search in Google Scholar PubMed PubMed Central

24. Schmidt, AF, Kannan, PS, Bridges, JP, Filuta, A, Lipps, D, Kemp, M, et al. Dosing and formulation of antenatal corticosteroids for fetal lung maturation and gene expression in rhesus macaques. Sci Rep 2019;9:9039. https://doi.org/10.1038/s41598-019-45171-6.Search in Google Scholar PubMed PubMed Central

Received: 2020-06-03

Accepted: 2020-10-02

Published Online: 2020-10-26

Published in Print: 2021-03-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2020-0249

Keywords for this article

antenatal corticosteroids (ACS); diabetes mellitus (DM); infants of diabetic mothers (IDM); neonatal intensive care unit (NICU); respiratory distress syndrome (RDS); transient tachypnoea of newborns (TTN)