Association between antenatal corticosteroid administration and neonatal
hypoglycaemia in infants born at term: an observational cohort study
Abstract
OBJECTIVE Assess whether antenatal corticosteroids for fetal lung
maturation are associated with hypoglycaemia in neonates born at term.
DESIGN Cohort study of term singleton deliveries over a 3-year period.
SETTING Tertiary UK hospital. POPULATION The cohort includes neonates
not exposed to corticosteroids; those exposed before 34 weeks because of
suspected preterm birth but delivered at term (group 1); those exposed
after 34 weeks because of anticipated late preterm birth (group 2); and
- included in the latter - a subgroup of neonates exposed within 7 days
of their actual delivery (group 2a). METHODS Retrospective analysis of
the association between exposure and neonatal outcomes using
multivariate regression to adjust for confounders. MAIN OUTCOME MEASURES
Severe neonatal hypoglycaemia requiring admission to NNU; and need for
ventilatory support. RESULTS Amongst 20102 eligible pregnancies, 143
women received corticosteroids before 34 weeks; and 187 after 34 weeks,
of which 106 were within 7 days of delivery. Severe hypoglycaemia
occurred in 227 neonates. Univariate predictors of hypoglycaemia were
maternal BMI, nulliparity, hypertension, diabetes, gestation at birth,
birthweight<10 centile and corticosteroid exposure. Following
adjustment for covariates, corticosteroid exposure was independently
associated with hypoglycaemia in all exposed groups: group 1 adjusted
odds ratio (aOR) 3.26 (1.38-7.73); group 2 aOR 4.56 (2.47-8.42); and
group 2a aOR 5.70 (2.49-13.03). Ventilatory support was not
significantly different in any of the exposed groups. CONCLUSION There
is increased risk of hypoglycaemia in neonates exposed to antenatal
corticosteroids who are born at term. The risk of hypoglycaemia is
higher with decreasing corticosteroid-to-birth interval.