Neonatal outcome in gestational-diabetic mothers treated with antenatal corticosteroids delivering at the late preterm and term
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To determine the association between antenatal corticosteroid treatment and neonatal complications in diabetic mothers delivering after 34 weeks of gestation.
A retrospective cohort study of women with singleton pregnancies diagnosed with gestational diabetes who delivered after 34 weeks of gestation in a university-affiliated medical center (2012–2016). Mothers treated with corticosteroids prior to 34 + 0 weeks of gestation were divided according to gestational age at delivery: late-preterm (34 + 0 to 36 + 6) and term (37 + 0 to 41 + 6). Each group was compared to women delivering at the same gestational age who were not treated with corticosteroids. Primary outcome was defined as a neonatal adverse composite outcome. Birth weight was amongst secondary outcomes measured. Logistic regression analysis was utilized to adjust results to potential confounders.
During the study period, 161 diabetic mothers delivered at late-preterm. Amongst them, 47 (30%) were treated with corticosteroids. 2101 diabetic mothers delivered at term, amongst them 82 (4%) were treated with corticosteroids. Primary outcome did not differ between groups. Multivariate analysis demonstrated that corticosteroid treatment was not associated with neonatal adverse composite outcome when delivery occurred at the late preterm, nor at term (adjusted odds ratio (aOR) = 0.708, 95% CI 0.2–2.3, p = 0.572, and aOR = 1.6, 95% CI 0.2–12.7, p = 0.635, respectively). Birth weight was significantly lower in women treated with corticosteroids (2486 vs. 2675 g, p = 0.02 at late-preterm, and 3160 vs. 3319 g, p < 0.001 at term).
Corticosteroid treatment for diabetic mothers was not associated with neonatal adverse outcomes, but was found associated with a lower birth weight, when delivery occurs after 34 weeks of gestation.
KeywordsAntenatal corticosteroids Gestational diabetes mellitus Late preterm Term
Respiratory distress syndrome
Transient tachypnea of the newborn
Gestational diabetes mellitus
Neonatal intensive care unit
Glucose challenge test
Oral glucose tolerance test
EK: protocol development, data analysis and manuscript writing. AH: manuscript writing, data analysis. RC: protocol development and manuscript editing. AW: protocol development and manuscript editing. EH: protocol development and manuscript editing. AB: protocol development, data analysis and manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Human and animal rights statement
This article does not contain any studies with animals performed by any of the authors.
- 2.Carlo WA, McDonald SA, Fanaroff AA, Vohr BR, Stoll BJ, Ehrenkranz RA et al (2011) Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 5 weeks’ gestation. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. JAMA 306:234858CrossRefGoogle Scholar
- 7.Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane database of Systematic Reviews 2006, 3Google Scholar
- 20.Wapner RJ, Sorokin Y, Thom EA, Johnson F, Dudley DJ, Spong CY et al (2006) Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Am J Obstet Gynecol 195:633–642CrossRefPubMedGoogle Scholar
- 21.Crowther CA, Haslam RR, Hiller JE, Doyle LW, Robinson JS (2006) Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomised controlled trial. Australasian Collaborative Trial of Repeat Doses of Steroids (ACTORDS) Study Group. Lancet 367:1913–1919CrossRefPubMedGoogle Scholar
- 27.Lazer S, Biale Y, Mazor M, Lewenthal H, Insler V (1986) Complications associated with the macrosomic fetus. J Repro Med 31:501–505Google Scholar
- 30.Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B et al (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. N Engl J Med 361:1339–1348CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L (2013) Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 159:123–129CrossRefPubMedGoogle Scholar