Is Exposure to Intrapartum Prostaglandins for Labor Induction Associated with a Lower Incidence of Neonatal Respiratory Distress Syndrome?

Shannon L. Son; Amanda A. Allshouse; Gretchen A. Heinrichs; Thomas J. Garite; Robert M. Silver; Ronald J. Wapner; William A. Grobman; Judith H. Chung; Brian M. Mercer; Torri D. Metz

doi:10.1055/s-0041-1728820

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2021; 38(10): 993-998
DOI: 10.1055/s-0041-1728820

SMFM Fellowship Series Article

Is Exposure to Intrapartum Prostaglandins for Labor Induction Associated with a Lower Incidence of Neonatal Respiratory Distress Syndrome?

Shannon L. Son

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah

,

Amanda A. Allshouse

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

,

Gretchen A. Heinrichs

³Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado

,

Thomas J. Garite

⁴Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Orange, California

,

Robert M. Silver

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah

,

Ronald J. Wapner

⁵Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York City, New York

,

William A. Grobman

⁶Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

,

Judith H. Chung

⁴Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Orange, California

,

Brian M. Mercer

⁷Department of Obstetrics & Gynecology, The MetroHealth System, Case Western Reserve University, Clevelend, Ohio

,

Torri D. Metz

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah

²Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah

› Institutsangaben

Abstract

Objective Respiratory distress syndrome (RDS) is implicated in 30% of neonatal deaths. Since prostaglandins promote surfactant secretion and labor is associated with a lower risk of RDS in term neonates, it is plausible that synthetic prostaglandin (sPG) exposure is associated with a lower risk of RDS. Thus, we evaluated the association between sPG exposure and RDS in neonates born after the induction of labor (IOL).

Study Design Secondary analysis of women with singleton pregnancies undergoing IOL at 34^0/7 to 42^0/7 weeks in the nuMoM2b study, a multicenter prospective cohort of nulliparous women. RDS rates and secondary neonatal outcomes in neonates with intrapartum sPG exposure were compared with those who had IOL with non-sPG methods (e.g., balloon catheter, amniotomy, oxytocin, and laminaria). Logistic regression models estimated the association of sPG with RDS and with secondary outcomes after adjustment for clinical and demographic factors (including gestational age). A sensitivity analysis was performed in which analysis was restricted to those with an admission cervical dilation ≤2 cm.

Results Of 10,038 women in the total cohort, 3,071 met inclusion criteria; 1,444 were exposed and 1,627 were unexposed to sPGs. Antenatal corticosteroid exposure rates were low (3.0%) and similar between groups. In univariable analysis, neonates with sPG exposure had higher rates of RDS (3.2 vs. 2.0%, odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.01–2.50). This relationship was similar by gestational age at delivery (term vs. preterm, interaction p = 0.14). After adjustment, the association between sPG and RDS was no longer significant (adjusted odds ratio: 1.4, 95% CI: 0.9–2.3). When analysis was restricted to subjects with admission cervical dilation of ≤2 cm, there was also no association between sPG exposure and RDS.

Conclusion In pregnancies between 34 and 42 weeks of gestation, exposure to sPG for cervical ripening or labor induction was not associated with newborn RDS.

Key Points

RDS is implicated in 30% of neonatal deaths.
sPG exposure was not associated with RDS.
Avoiding preterm birth remains crucial in RDS prevention.

Keywords

respiratory distress syndrome - neonatal respiratory distress syndrome - prostaglandin - neonatal morbidity - neonatal mortality - induction of labor

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Referenzen

References
1 Whitsett J, Rice W, Warner B, Wert S, Pryhuber G. Acute respiratory disorders. In: Avery's Neonatology: Pathophysiology and Management of the Newborn. 6th ed.. Lippincott: Williams & Wilkins; 2005: 553-577
2 Helve O, Pitkänen OM, Andersson S, O'Brodovich H, Kirjavainen T, Otulakowski G. Low expression of human epithelial sodium channel in airway epithelium of preterm infants with respiratory distress. Pediatrics 2004; 113 (05) 1267-1272
3 Bland R, Carlton D, Jain L. Lung fluid balance during development in neonatal lung disease. In: The Newborn Lung: Neonatology Questions and Controversies. 1st ed.. Saunders; 2008: 141-165
4 Harrison V. The Newborn Baby. 5th ed.. Juta & Company Ltd; 2008
5 Respiratory Morbidity in Late Preterm Births. JAMA 2010; 304 (04) 419-425
6 Li Y, Zhang C, Zhang D. Cesarean section and the risk of neonatal respiratory distress syndrome: a meta-analysis. Arch Gynecol Obstet 2019; 300 (03) 503-517
7 Indraccolo U, Pace M, Corona G, Bonito M, Indraccolo SR, Di Iorio R. Cesarean section in the absence of labor and risk of respiratory complications in newborns: a case-control study. J Matern Fetal Neonatal Med 2019; 32 (07) 1160-1166
8 Singh M, Patole S, Rane A, Naidoo D, Buettner P. Maternal intravaginal prostaglandin E2 gel before elective caesarean section at term to induce catecholamine surge in cord blood: randomised, placebo controlled study. Arch Dis Child Fetal Neonatal Ed 2004; 89 (02) F131-F135
9 Motaze NV, Mbuagbaw L, Young T. Prostaglandins before caesarean section for preventing neonatal respiratory distress. Cochrane Pregnancy and Childbirth Group, ed. Cochrane Database of Systematic Reviews. Published online November 11, 2013
10 Haas DM, Parker CB, Wing DA. et al; NuMoM2b study. A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b). Am J Obstet Gynecol 2015; 212 (04) 539.e1-539.e24