(1118) Late Preterm Glucocorticoid Administration in Subpopulations at Increased Risk

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: The ALPS trial demonstrated neonatal benefit in late preterm glucocorticoid administration in addition to an increased risk of neonatal hypoglycemia but excluded twin gestations and pre-gestational diabetics. Our objective was to examine maternal and neonatal outcomes of glucocorticoid administration for these subpopulations at increased risk for respiratory distress syndrome (RDS).

Study Design: This was a single-center retrospective observational cohort study of patients delivering late preterm (34w0d to 36w6d) at our institution from 07/2017 to 05/2021. Patients with pre-gestational and gestational diabetes and twin gestations were included. Higher order gestations, intrauterine fetal demises, and fetal anomalies were excluded. Steroid treatment was most commonly betamethasone 12mg IM q24 x2 doses. Tocolysis was not routinely administered to complete treatment. Two-sample t-tests and Fisher’s exact tests were used for quantitative and categorical variables, respectively.

Results:

158 patients were included: 88 received antenatal corticosteroids, 70 did not (Table 1). For twin gestations (n=60), 30 received steroids (50%). Among all diabetic patients (n=98), 58 (59%) received steroids. For pre-gestational diabetics (n=51), 28 (54%) were treated. No statistically significant differences in neonatal outcomes were noted for all patients and the subpopulations of twins, pre-gestational, and gestational diabetics (Table 2).

Rates of RDS in all patients (48% vs. 47%), twins (47% vs. 47%), and diabetics (50% vs. 46%) did not differ significantly. Intubation rates also did not differ between groups. Neonatal hypoglycemia rates were increased but did not reach statistical significance in all patients (47% vs. 35%, P= 0.1549), twins (37% vs. 25%, P= 0.270), and diabetics (57% vs. 50%, P= 0.541).

Conclusion: Antenatal corticosteroid treatment of twin gestations and diabetic patients did not lead to an identifiable difference in RDS despite these populations being at remarkable risk. Safety analysis is limited by sample size.

Primary & Presenting Author(s)

Pranaya Chilukuri, MD (she/her/hers)
Resident Physician
University of Kentucky
Lexington, KY, United States

Coauthor(s)

Calvin L. Ward, MD
Fellow
University of Kentucky College of Medicine
Lexington, Kentucky, United States
MR
Mallory Ritter, BS
University of Kentucky College of Medicine
Lexington, Kentucky, United States
CC
Cynthia Cockerham, BS, RN
Department of OBGYN, Division of Maternal Fetal Medicine, University of Kentucky
Lexington, Kentucky, United States
GH
Gregory Hawk, PhD
Postdoctoral scholar
Department of Statistics, University of Kentucky
Lexington, Kentucky, United States
AS
Arnold J. Stromberg, MS, PhD
Department of Statistics, University of Kentucky
Lexington, Kentucky, United States
JO
John O'Brien, MD
Chandler Medical Center, University of Kentucky
Lexington, Kentucky, United States