Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
Am J Obstet Gynecol. 2021 Nov;225(5):536.e1-536.e7. doi: 10.1016/j.ajog.2021.04.251. Epub 2021 May 3.
Antenatal corticosteroids improve newborn outcomes for preterm infants. However, predicting which women presenting for threatened preterm labor will have preterm infants is inaccurate, and many women receive antenatal corticosteroids but then go on to deliver at term.
This study aimed to compare the short-term outcomes of infants born at term to women who received betamethasone for threatened preterm labor with infants who were not exposed to betamethasone in utero.
We performed a retrospective cohort study of infants born at or after 37 weeks' gestational age to mothers diagnosed as having threatened preterm labor during pregnancy. The primary neonatal outcomes of interest included transient tachypnea of the newborn, neonatal intensive care unit admission, and small for gestational age and were evaluated for their association with betamethasone exposure while adjusting for covariates using multiple logistic regression.
Of 5330 women, 1459 women (27.5%) received betamethasone at a mean gestational age of 32.2±3.3 weeks. The mean age of women was 27±5.9 years and the mean gestational age at delivery was 38.9±1.1 weeks. Women receiving betamethasone had higher rates of maternal comorbidities (P<.001 for diabetes mellitus, asthma, and hypertensive disorder) and were more likely to self-identify as White (P=.022). Betamethasone-exposed neonates had increased rates of transient tachypnea of the newborn, neonatal intensive care unit admission, small for gestational age, hyperbilirubinemia, and hypoglycemia (all, P<.05). Controlling for maternal characteristics and gestational age at delivery, betamethasone exposure was not associated with a diagnosis of transient tachypnea of the newborn (adjusted odds ratio, 1.10; 95% confidence interval, 0.80-1.51), although it was associated with more neonatal intensive care unit admissions (adjusted odds ratio, 1.49; 95% confidence interval, 1.19-1.86) and higher odds of the baby being small for gestational age (adjusted odds ratio, 1.78; 95% confidence interval, 1.48-2.14).
Compared with women evaluated for preterm labor who did not receive betamethasone, women receiving betamethasone had infants with higher rates of neonatal intensive care unit admission and small for gestational age. Although the benefits of betamethasone to infants born preterm are clear, there may be negative impacts for infants delivered at term.
产前皮质激素可改善早产儿的新生儿结局。然而，预测哪些有早产威胁的孕妇会分娩早产儿并不准确，许多孕妇接受了产前皮质激素治疗，但随后仍在足月分娩。
本研究旨在比较因早产威胁而接受倍他米松治疗的足月分娩婴儿与未在宫内接受倍他米松治疗的婴儿的短期新生儿结局。
我们对妊娠期间被诊断为早产威胁的母亲分娩的胎龄在 37 周及以上的婴儿进行了回顾性队列研究。主要新生儿结局包括新生儿暂时性呼吸急促、新生儿重症监护病房入院和小于胎龄儿，并用多变量逻辑回归来评估它们与倍他米松暴露的相关性，并调整了协变量。
在 5330 名妇女中，1459 名妇女（27.5%）在平均孕龄 32.2±3.3 周时接受了倍他米松治疗。妇女的平均年龄为 27±5.9 岁，平均分娩孕龄为 38.9±1.1 周。接受倍他米松治疗的妇女有更高的母体合并症发生率（糖尿病、哮喘和高血压疾病，均 P<.001），并且更有可能自认为是白人（P=.022）。倍他米松暴露的新生儿新生儿暂时性呼吸急促、新生儿重症监护病房入院、小于胎龄儿、高胆红素血症和低血糖症的发生率更高（均 P<.05）。在控制了母亲特征和分娩孕龄后，倍他米松暴露与新生儿暂时性呼吸急促的诊断无关（调整后的优势比，1.10；95%置信区间，0.80-1.51），尽管它与更多的新生儿重症监护病房入院有关（调整后的优势比，1.49；95%置信区间，1.19-1.86），并且婴儿小于胎龄儿的可能性更高（调整后的优势比，1.78；95%置信区间，1.48-2.14）。
与未接受倍他米松治疗的因早产威胁而接受评估的孕妇相比，接受倍他米松治疗的孕妇的新生儿重症监护病房入院率和小于胎龄儿的发生率更高。虽然产前皮质激素对早产儿出生的婴儿有明确的益处，但对足月分娩的婴儿可能有负面影响。
