Antenatal corticosteroid therapy in late preterm delivery: a nationwide population-based retrospective study in Taiwan

Antenatal corticosteroid therapy in late preterm delivery: a nationwide population-based retrospective study in Taiwan

Preterm newborns often experience respiratory distress syndrome at birth due to incomplete lung development. Consequently, international organizations, such as the World Health Organization and the American College of Obstetricians and Gynecologists, recommend administering prenatal corticosteroids, including Betamethasone or Dexamethasone, to pregnant women at risk of preterm delivery, particularly for births before 34 weeks of gestation to accelerate fetal organ maturation and decrease the risks of complications such as respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage in preterm infants. However, there is ongoing debate about whether these clinical guidelines are also applicable to pregnant women having risk of preterm birth at 34 to 36 weeks, particularly regarding the potential long-term neurological effects.

This study, using data from national health insurance, birth registry, and maternal and child health databases, focuses on late preterm infants born between 2004 and 2011. It compares short-term complications and long-term neurological development in newborns born to women who had corticosteroids during pregnancy with those born to women without the treatment. The findings indicate that compared to newborns whose mothers did not receive corticosteroids during pregnancy, newborns born to women administered corticosteroids reduced the need for continuous positive airway pressure, the number of neonatal intensive care unit administration, and the need for glucose administration, as well as the risk of respiratory distress. But the risk of neonatal sepsis was higher, approximately 1.16 times (95% CI=1.06-1.28). Furthermore, the study revealed a correlation between the timing of corticosteroid administration and subsequent neurological developmental disorders in children. Newborns whose mothers received corticosteroids before 34 weeks of gestation had an increased risk of neurodevelopmental disorders (aHR: 1.10, 95% CI: 1.02-1.20) during the school-age period compared to the control group. This negative impact was more pronounced in infants born to diabetic mothers (aHR: 1.43, 95% CI: 1.13-1.80).

Application and Highlights:

1.Before administrating prenatal steroids, doctors should assess the specific conditions of pregnant

women, such as their health status during pregnancy, the presence of chronic diseases, gestational

age, and factors related to the risk of preterm birth, and discuss with the pregnant women

regarding the benefits and risks of treatment for making the optimal medical decisions.

2.Clinical trials rarely prioritize pregnant women and children for medication interventions due to

their vulnerability. This study links various administrative data to investigate a nationwide birth

cohort’s short-term health conditions and longitudinally tracks their neurodevelopment.

The evidence-based results from this real-world research can serve as a reference for clinical decision-

making.

Research Team Members: Fu-Wen Liang, Hao-Wei Chung

Representative Department: Center for Big Data Research, Kaohsiung Medical University

Contact Email: fwliang@kmu.edu.tw

Publication:

1.Liang FW, Tsai HF, Kuo PL, Tsai PY. Antenatal corticosteroid therapy in late preterm delivery: a

nationwide population-based retrospective study in Taiwan. BJOG. 2021;128(9):1497-1502.

doi:10.1111/1471-0528.16677

2.Chung HW, Yu CH, Huang CY, Liang FW. Gender Difference in Neurodevelopment Disorders Among

Late Preterm Infants: Exploring the Impact of Antenatal Corticosteroid Timing. Indian J Pediatr.

Published online December 7, 2023. doi:10.1007/s12098-023-04966-2

Full-Text Article:

https://pubmed.ncbi.nlm.nih.gov/33629515/

https://pubmed.ncbi.nlm.nih.gov/38060152/