Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2019 Feb;299(2):403-409. doi: 10.1007/s00404-018-4976-1. Epub 2018 Nov 26.
To evaluate the association between antenatal corticosteroid treatment and neonatal outcome when delivery occurs at term.
A retrospective cohort study of all women with singleton gestations who delivered at term (37 + 0 to 41 + 6 weeks) in a tertiary medical center (2012-2015). Women with diabetes, suspected fetal growth restriction, antepartum fetal death, and fetal structural or chromosomal anomalies were excluded. The cohort was divided according to prior preterm (24 + 0 to 33 + 6 weeks) antenatal corticosteroids treatment due to threatened preterm labor (study group), vs. no such treatment (control group). Primary outcome was birthweight at delivery. Secondary outcomes were composites neonatal adverse outcomes. Logistic regression analysis was utilized to adjust results for potential confounders.
Of 25,872 women who were included in the study, 722 (3%) were treated with antenatal corticosteroids. Women in the treatment group had higher rates of nulliparity compared to controls (43% vs. 38%, p = 0.002). Birth weight was significantly lower in the corticosteroid treatment group (3077 g vs. 3264 g, p = 0.001), with higher rates of small for gestational age (11% vs. 6%, p = 0.001). Multivariate analysis adjusting for parity and gestational age demonstrated that corticosteroid treatment was associated with lower birth weight (B = - 93 g, 95% CI - 123 to - 66, p = 0.001). Treatment was not found to be associated with adverse neonatal outcomes composites.
Antenatal corticosteroid treatment is associated with lower birth weight and higher rates of small for gestational age neonates among women who eventually deliver at term. However, it is not associated with short-term adverse neonatal outcomes.
评估在足月时分娩时产前皮质类固醇治疗与新生儿结局之间的关联。
这是一项对在三级医疗中心分娩的所有单胎妊娠足月妇女（37+0 至 41+6 周）的回顾性队列研究。排除患有糖尿病、疑似胎儿生长受限、产前胎儿死亡和胎儿结构或染色体异常的女性。该队列根据既往因早产威胁（研究组）而接受的产前皮质类固醇治疗或未接受此类治疗（对照组）进行分组。主要结局是分娩时的出生体重。次要结局是新生儿不良复合结局。利用逻辑回归分析调整潜在混杂因素的结果。
在纳入研究的 25872 名女性中，有 722 名（3%）接受了产前皮质类固醇治疗。治疗组的初产妇比例明显高于对照组（43% vs. 38%，p=0.002）。皮质类固醇治疗组的出生体重明显较低（3077g vs. 3264g，p=0.001），且胎儿生长受限的发生率较高（11% vs. 6%，p=0.001）。多变量分析调整了初产妇比例和胎龄，表明皮质类固醇治疗与较低的出生体重有关（B=-93g，95%CI-123 至-66，p=0.001）。治疗与不良新生儿结局复合并无关联。
在最终足月分娩的女性中，产前皮质类固醇治疗与较低的出生体重和较高的胎儿生长受限发生率有关。然而，它与短期不良新生儿结局无关。
