Am J Perinatol
DOI: 10.1055/a-2183-5062
Original Article

Neonatal Hypoglycemia following Late Preterm Antenatal Corticosteroid Administration in Individuals with Diabetes in Pregnancy

1   Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
,
John M. Perino
1   Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
,
Sophie Fisher
1   Columbia University, Vagelos College of Physicians and Surgeons, New York, New York
,
Yijia Zhang
2   Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons, Columbia University Irving Medical Center, New York, New York
3   Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
,
Vidhu Thaker
4   Division of Molecular Genetics and Pediatric Endocrinology, Department of Pediatrics, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
,
Noelia M. Zork
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
› Author Affiliations

Abstract

Objective Antenatal corticosteroid (ACS) administration is standard practice for pregnant individuals delivering in the late preterm period, though no guidelines are in place for those with diabetes. This study aims to characterize the prevalence of neonatal hypoglycemia after ACS administration in pregnant individuals with diabetes delivering in the late preterm period.

Study Design This is a retrospective, single-center, case–control study of individuals with diabetes who delivered between 340/7 and 366/7 weeks' gestation at a large academic medical center from 2016 to 2021. A total of 169 individuals were included in the analysis; 87 received corticosteroids and 82 did not. The proportion of neonates with hypoglycemia, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, and hyperbilirubinemia were compared between parents who received ACSs versus those who did not.

Results The prevalence of neonatal hypoglycemia (40.2 vs. 23.2%, p = 0.027), requiring treatment (40.3 vs. 22.4%, p = 0.041), and hyperbilirubinemia (35.6 vs 18.5%, p = 0.018) was greater for neonates born to individuals with diabetes who received late preterm ACSs compared with those who did not. There was no difference in NICU admission and respiratory distress between the groups. These results remained unchanged after controlling for confounders including gestational age at delivery and birth weight.

Conclusion This study demonstrates that late preterm corticosteroid administration to pregnant individuals with diabetes increases the risk for neonatal hypoglycemia without changing the rates of respiratory morbidity.

Key Points

  • Late preterm ACS in diabetic patients resulted in higher rates of neonatal hypoglycemia.

  • There are no differences in rates of respiratory distress syndrome and transient tachypnea of the newborn between the ACS group and control group.

  • There was no noted difference in rate of NICU admission and length of stay between the two groups.



Publication History

Received: 16 June 2023

Accepted: 26 September 2023

Accepted Manuscript online:
28 September 2023

Article published online:
10 November 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Harrison MS, Goldenberg RL. Global burden of prematurity. Semin Fetal Neonatal Med 2016; 21 (02) 74-79
  • 2 Natarajan G, Shankaran S. Short- and long-term outcomes of moderate and late preterm infants. Am J Perinatol 2016; 33 (03) 305-317
  • 3 Committee on Obstetric Practice. Committee opinion no. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol 2017; 130 (02) e102-e109
  • 4 Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consens Statement 1994; 12 (02) 1-24
  • 5 Gyamfi-Bannerman C, Thom EA, Blackwell SC. et al; NICHD Maternal–Fetal Medicine Units Network. antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 374 (14) 1311-1320
  • 6 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 (12) CD004454
  • 7 Werner EF, Romano ME, Rouse DJ. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU)*. Association of gestational diabetes mellitus with neonatal respiratory morbidity. Obstet Gynecol 2019; 133 (02) 349-353
  • 8 Langen ES, Kuperstock JL, Sung JF, Taslimi M, Byrne J, El-Sayed YY. Maternal glucose response to betamethasone administration. Am J Perinatol 2015; 30 (02) 143-148
  • 9 Jolley JA, Rajan PV, Petersen R, Fong A, Wing DA. Effect of antenatal betamethasone on blood glucose levels in women with and without diabetes. Diabetes Res Clin Pract 2016; 118: 98-104
  • 10 Kalhan S, Parimi P. Gluconeogenesis in the fetus and neonate. Semin Perinatol 2000; 24 (02) 94-106
  • 11 Kole MB, Ayala NK, Clark MA, Has P, Esposito M, Werner EF. Factors associated with hypoglycemia among neonates born to mothers with gestational diabetes mellitus. Diabetes Care 2020; 43 (12) e194-e195
  • 12 Rozance PJ, Hay WW. Hypoglycemia in newborn infants: features associated with adverse outcomes. Biol Neonate 2006; 90 (02) 74-86
  • 13 Cornblath M, Hawdon JM, Williams AF. et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000; 105 (05) 1141-1145
  • 14 Kaiser JR, Bai S, Gibson N. et al. Association between transient newborn hypoglycemia and fourth-grade achievement test proficiency: a population-based study. JAMA Pediatr 2015; 169 (10) 913-921
  • 15 Reddy UM, Deshmukh U, Dude A, Harper L, Osmundson SS. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. Society for Maternal-Fetal Medicine Consult Series #58: Use of antenatal corticosteroids for individuals at risk for late preterm delivery: Replaces SMFM Statement #4, Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery, August 2016. Am J Obstet Gynecol 2021; 225 (05) B36-B42
  • 16 Battarbee AN, Clapp MA, Boggess KA. et al. Practice variation in antenatal steroid administration for anticipated late preterm birth: a physician survey. Am J Perinatol 2019; 36 (02) 200-204
  • 17 Adamkin DH. Committee on Fetus and Newborn. Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics 2011; 127 (03) 575-579
  • 18 Gyamfi-Bannerman C, Jablonski KA, Blackwell SC. et al; Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network. Evaluation of hypoglycemia in neonates of women at risk for late preterm delivery: an antenatal late preterm steroids trial cohort study. Am J Perinatol 2023; 40 (05) 532-538
  • 19 Gupta K, Rajagopal R, King F, Simmons D. Complications of antenatal corticosteroids in infants born by early term scheduled cesarean section. Diabetes Care 2020; 43 (04) 906-908
  • 20 Ali H, Salama H, Robertson N. et al. Antenatal corticosteroids and short-term neonatal outcomes in term and near-term infants of diabetic mothers. Analysis of the Qatar PEARL-peristat registry. J Perinat Med 2020; 49 (03) 377-382
  • 21 Dude AM, Yee LM, Henricks A, Eucalitto P, Badreldin N. Neonatal hypoglycemia after antenatal late preterm steroids in individuals with diabetes. J Perinatol 2021; 41 (12) 2749-2753