483: Antenatal corticosteroids in preterm growth-restricted fetuses: A systematic review and meta- analysis

Abstract

Prior studies evaluating antenatal corticosteroids (ACS) and preterm birth outcomes have largely excluded patients with fetal growth restriction (FGR), resulting in limited evidence to guide ACS use in these pregnancies. Because growth-restricted fetuses are exposed to higher levels of endogenous steroids, exogenous ACS may not offer additional benefit. We conducted a systematic review and meta-analysis to evaluate the effect of ACS on neonatal outcomes in patients with preterm FGR. We conducted a predefined, systematic search in MEDLINE using relevant search terms. Selected studies were cohort or case-control studies comparing neonatal mortality and morbidity among FGR pregnancies delivered preterm that received ACS to those that did not. The primary outcome was neonatal mortality. Secondary outcomes were composite neonatal morbidity, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), intraventricular hemorrhage and/or periventricular leukomalacia (IVH/PVL), bronchopulmonary dysplasia or chronic lung disease of prematurity (BPD/CLD), or neonatal sepsis. We assessed heterogeneity via Higgins I2, and calculated pooled odds ratios (OR) with 95% confidence intervals (CI) using random effects models. Thirteen studies published 1995-2018 met selection criteria including 6,387 FGR pregnancies delivered from 22-35 weeks’ gestational age. Of these, 3,554 (55.6%) received ACS and 2457 (44.4%) did not. Neonatal mortality was significantly lower in patients who received ACS compared to those who did not (12 studies: 12.8% vs. 15.1%, OR 0.63 [95% CI 0.46, 0.86]), with significant heterogeneity between studies (I2=55.1%). There was no significant difference in composite neonatal morbidity (4 studies: OR 0.73 [95% CI 0.53, 1.00]), RDS (12 studies: OR 0.89 [95% CI 0.69, 1.15]), NEC (7 studies: OR 0.93 [95% CI 0.70, 1.22]), IVH/PVL (10 studies: OR 0.82 [95% CI 0.56, 1.19]), BPD/CLD (8 studies: OR 1.11 [95% CI 0.88, 1.41]), or neonatal sepsis (6 studies: OR 1.23 [95% CI 0.94, 1.62]). These data show that ACS reduces neonatal mortality in pregnancies with FGR delivered preterm, with no apparent effect on measures of neonatal morbidity. This supports continued use of ACS for reduction of neonatal mortality in pregnancies with FGR at risk for preterm birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)