Effects of antenatal dexamethasone for maternal antepartum haemorrhage on term babies

Ka Wai Kong; Kwok Yin Leung

doi:10.12809/hkjgom.23.2.341

Authors

Ka Wai Kong
Kwok Yin Leung

DOI:

https://doi.org/10.12809/hkjgom.23.2.341

Keywords:

Apgar score, Dexamethasone, Infant, small for gestational age, Intensive care units, neonatal

Abstract

Objective: This study aims to compare the outcomes of term babies with or without in utero exposure to dexamethasone as a result of maternal antepartum haemorrhage (APH).
Methods: Medical records of women with antepartum haemorrhage who had a singleton livebirth delivered at ≥37 weeks of gestation in the Queen Elizabeth Hospital, Hong Kong, between 1 January 2019 and 31 December 2021 were retrospectively reviewed. Primary outcomes were the small-for-gestational-age (SGA) rate, the neonatal intensive care unit (NICU) admission rate, and low Apgar score at 5 minutes. Secondary outcomes were the Caesarean section rate and the operative vaginal delivery rate.
Results: A total of 898 women were included; 50 (5.6%) of them had completed a course of antenatal dexamethasone. Compared with women without antenatal dexamethasone, women with antenatal dexamethasone were associated with higher rates of gestational diabetes mellitus (22% vs 7.2%, p<0.001), operative vaginal delivery (16% vs 9.8%, p=0.005), earlier gestational week at delivery (38.2 vs 39.2 weeks, p<0.001), and lower neonatal birthweight (3001.4 vs 3149.6 g, p=0.004). In logistic regression analysis, antenatal exposure to dexamethasone was associated with an increased risk of having an operative vaginal delivery (adjusted odds ratio=2.98, p=0.016) and a reduced risk of having an SGA baby for every 1-week increase in pregnancy (adjusted odds ratio=0.69, p=0.002).
Conclusion: Antenatal dexamethasone for women with antepartum haemorrhage was not associated with SGA infants, NICU admission, or low Apgar score but was associated with earlier delivery, lower neonatal birthweight, and a higher rate of operative vaginal delivery. The latter remained significant in logistic regression analysis. More studies are needed to identify any potential effects on term babies exposed to antenatal corticosteroids.

References

Stock SJ, Thomson AJ, Papworth S; Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality: Green-top Guideline No. 74. BJOG 2022;129:e35-60.

McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2020;12:CD004454.

Magann EF, Cummings JE, Niederhauser A, Rodriguez-Thompson D, McCormack R, Chauhan SP. Antepartum bleeding of unknown origin in the second half of pregnancy: a review. Obstet Gynecol Surv 2005;60:741-5. DOI: https://doi.org/10.1097/01.ogx.0000182881.53139.f7

Antepartum haemorrhage. Green-top Guideline No. 63. London: Royal College of Obstetricians and Gynaecologists; 2011.

Williams MJ, Ramson JA, Brownfoot FC. Different corticosteroids and regimens for accelerating fetal lung maturation for babies at risk of preterm birth. Cochrane Database Syst Rev 2022;8:CD006764.

McKinzie A, Yang Z, Teal E, et al. Are newborn outcomes different for term babies who were exposed to antenatal corticosteroids? Am J Obstet Gynecol 2021;225:536.e1-7.

Cheng YKY, Lu J, Leung TY, Chan YM, Sahota DS. Prospective assessment of INTERGROWTH-21st and World Health Organization estimated fetal weight reference curves. Ultrasound Obstet Gynecol 2018;51:792-8. DOI: https://doi.org/10.1002/uog.17514

Sarid EB, Stoopler ML, Morency AM, Garfinkle J. Neurological implications of antenatal corticosteroids on late preterm and term infants: a scoping review. Pediatr Res 2022;92:1225-39.

Osteen SJ, Yang Z, McKinzie AH, et al. Long-term childhood outcomes for babies born at term who were exposed to antenatal corticosteroids. Am J Obstet Gynecol 2023;228:80.e1-6.

Muche AA, Olayemi OO, Gete YK. Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth 2020;20:73.

Taleghani AA, Bhriguvanshi A, Kamath-Rayne BD, Liu C, Narendran V. Timing of antenatal steroid administration and effects on the newborn infant: a retrospective study. Am J Perinatol 2022;39:1065-73.

Gorgal R, Gonçalves E, Barros M, et al. Gestational diabetes mellitus: a risk factor for non-elective cesarean section. J Obstet Gynaecol Res 2012;38:154-9. DOI: https://doi.org/10.1111/j.1447-0756.2011.01659.x

Jian Yun X, Zhaoxia L, Yun C, Qin F, Yuanyuan C, Danqing C. Changes in maternal glucose metabolism after the administration of dexamethasone for fetal lung development. Int J Endocrinol 2012;2012:652806. DOI: https://doi.org/10.1155/2012/652806

Berghella V, Saccone G. Fetal fibronectin testing for reducing the risk of preterm birth. Cochrane Database Syst Rev 2019;7:CD006843.

Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G. Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol 2010;35:54-64. DOI: https://doi.org/10.1002/uog.7457

Leung TY, Chan LW, Tam WH, Leung TN, Lau TK. Risk and prediction of preterm delivery in pregnancies complicated by antepartum hemorrhage of unknown origin before 34 weeks. Gynecol Obstet Invest 2001;52:227-31. DOI: https://doi.org/10.1159/000052980

Walters A, McKinlay C, Middleton P, Harding JE, Crowther CA. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2022;4:CD003935.

Kong GW, Tam WH, Sahota DS, Nelson EA. Smoking pattern during pregnancy in Hong Kong Chinese. Aust N Z J Obstet Gynaecol 2008;48:280-5. DOI: https://doi.org/10.1111/j.1479-828X.2008.00840.x