595: The safety and efficacy of betamethasone in late-preterm mothers with pregestational diabetes

Abstract

Women with pregestational diabetes (pGDM) were excluded from the 2016 ALPS trial assessing the benefits of betamethasone (BMZ) administered for late preterm delivery. However, at many institutions, diabetic women delivering between 34 and 37 weeks are still offered steroids for lung development. We assessed the safety and efficacy of BMZ administration in this population. This is a retrospective cohort study of all women with pGDM who delivered between 34 weeks 0 days and 36 weeks 6 days at a single academic center from 2014 to 2019. Demographics and neonatal outcomes were collected by ICD coding, then manually reviewed. Women who received BMZ < 34 weeks gestation, had known fetal anomalies, or had uncertain dating were excluded. Differences in outcomes between patients with pGDM who did and did not receive BMZ in the late preterm period were evaluated using appropriate bivariate tests. Seventy cases of late preterm delivery among mothers affected by pGDM were identified during the study period. Thirty (42.9%) women received BMZ for anticipated early delivery. There were no neonatal deaths in either cohort. The median time between first BMZ dose and delivery was 47.9 hours (min 2.5, max 403.2). Eight (26.7%) neonates in the BMZ cohort required respiratory support (e.g., nasal cannula), compared to 22 (55.0%) among those not exposed to BMZ. BMZ administration was associated with a significant decrease in respiratory support needs (OR 0.334, p=0.049) and severe respiratory outcomes (i.e., respiratory failure and bronchodysplasia; OR 0.276, p=0.036). BMZ administration did not significantly reduce NICU admission rates (OR 0.555, p=0.321) or length of stay (p=0.891). There was no significant association between BMZ and neonatal hypoglycemia (86.7% vs 92.5%, p=0.452). BMZ administration to mothers with pGDM in the late preterm period is associated with improved neonatal outcomes without a significant threat of neonatal hypoglycemia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)