Are newborn outcomes different for term babies who were exposed to antenatal corticosteroids?
Are newborn outcomes different for term babies who were exposed to antenatal corticosteroids?
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DOI：
10.1016/j.ajog.2021.04.251
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发表时间：
2021-11
影响因子：
9.8
通讯作者：
Haas DM
中科院分区：
文献类型：
--
作者：
McKinzie AH;Yang Z;Teal E;Daggy JK;Tepper RS;Quinney SK;Rhoads E;Haneline LS;Haas DM
皮质类固醇激素可改善早产儿的新生儿结局。然而，预测哪些先兆早产的妇女会有早产儿是不准确的，许多妇女接受产前皮质类固醇，但随后继续足月分娩。本研究的目的是比较足月出生的婴儿与接受倍他米松（BMZ）治疗先兆早产的妇女和子宫内未暴露于BMZ的婴儿的短期结局。我们进行了一项回顾性队列研究，研究对象是妊娠期被诊断为先兆早产的母亲在胎龄（GA）37周或37周后出生的婴儿。关注的主要新生儿结局包括新生儿一过性呼吸急促（TTN）、新生儿重症监护室（NICU）入院和小于胎龄儿（SGA），并评价其与BMZ暴露的相关性，同时使用多元logistic回归校正协变量。在5330名女性中，1459名（27.5%）女性接受BMZ治疗，平均GA为32.2±3.3周。女性的平均年龄为27±5.9岁，分娩时的平均GA为38.9±1.1周。接受BMZ治疗的妇女有较高的母亲合并症发生率（糖尿病、哮喘和高血压疾病P<0.001），并且更可能自我认同为白色（P=0.022）。BMZ暴露的新生儿TTN、NICU入院、SGA、高胆红素血症和低血糖的发生率增加（所有P值<0.05）。控制母体特征和分娩时GA，BMZ暴露与TTN的诊断无显著相关性（aOR 1.10，95% CI 0.80-1.51），但与更多的新生儿重症监护室入院相关（aOR 1.49，95%CI 1.19-1.86）和婴儿小于胎龄的几率更高（SGA，aOR 1.78，95%CI 1.48 - 2.14）。与未接受BMZ治疗的早产妇女相比，接受BMZ治疗的妇女的新生儿入住NICU和SGA率更高。虽然BMZ对早产儿的益处是明确的，但对足月分娩的婴儿可能有负面影响。与未暴露于产前皮质类固醇的婴儿相比，因先兆早产而暴露于产前皮质类固醇的足月新生儿入住重症监护室的比例更高，出生体重更低。
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. The purpose of this study was to compare the short-term outcomes of infants born at term to women who received betamethasone (BMZ) for threatened preterm labor to infants who were not exposed to BMZ in utero. We performed a retrospective cohort study of infants born at or after 37 weeks’ gestational age (GA) to mothers diagnosed with threatened preterm labor during pregnancy. The primary neonatal outcomes of interest included transient tachypnea of the newborn (TTN), neonatal intensive care unit (NICU) admission, and small for gestational age (SGA), and were evaluated for their association with BMZ exposure while adjusting for covariates using multiple logistic regression. Of 5330 women, 1459 (27.5%) women received BMZ at a mean GA of 32.2±3.3 weeks. The mean age of women was 27±5.9 years-old and the mean GA at delivery was 38.9±1.1 weeks. Women receiving BMZ had higher rates of maternal comorbidities (P<0.001 for diabetes, asthma, and hypertensive disorder) and were more likely to self-identify as white (P=0.022). BMZ-exposed neonates had increased rates of TTN, NICU admission, SGA, hyperbilirubinemia, and hypoglycemia (all P-values <0.05). Controlling for maternal characteristics and GA at delivery, BMZ exposure was not significantly associated with diagnosis of TTN (aOR 1.10, 95% CI 0.80-1.51), though it was associated with more NICU admissions (aOR 1.49, 95% CI 1.19-1.86) and higher odds of the baby being small for gestational age (SGA, aOR 1.78, 95%CI 1.48 to 2.14). Compared to women evaluated for preterm labor that did not receive BMZ, women receiving BMZ had infants with higher rates of NICU admission and SGA. While the benefits of BMZ to infants born preterm are clear, there may be negative impacts for infants delivered at term. Term newborns who were exposed to antenatal corticosteroids for threatened preterm labor had higher rates of intensive care unit admissions and lower birthweights than babies not exposed to antenatal corticosteroids.
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