Abstract
BackgroundThis study synthesizes available evidence on antenatal corticosteroids (ACS) use among special subgroups of women at risk of imminent preterm birth, including those (1) with pregestational and gestational diabetes mellitus, (2) undergoing elective caesarean section (CS) in late preterm (34 to<37 weeks), (3) with chorioamnionitis, and (4) with growth-restricted fetuses.MethodsA systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, POPLINE, and World Health Organization Regional Databases was conducted for all comparative studies. Two reviewers independently determined study eligibility, extracted data, and assessed study quality. Pooled mean differences and odds ratios with 95% confidence intervals were estimated from available data, based on fixed- and random-effects models, as appropriate.ResultsNo eligible studies were identified for ACS use in diabetic pregnant women or those undergoing elective CS at late preterm. Nine studies each on ACS use in women with chorioamnionitis and in women with fetal growth restriction met inclusion criteria; eight studies were separately included in the meta-analyses for the two subpopulations. For ACS administration in women with chorioamnionitis, pooled analyses showed reductions in neonatal mortality (OR: 0.49, 95% CI: 0.34–0.73), respiratory distress syndrome (OR: 0.58, 95% CI: 0.44–0.76), intraventricular haemorrhage (OR: 0.41, 95% CI: 0.24–0.69), and severe intraventricular haemorrhage (OR: 0.40, 95% CI: 0.24–0.69). Maternal and long-term newborn outcomes were not reported. Effects of ACS use were inconclusive for cases with fetal growth restriction.ConclusionDirect evidence on the effectiveness and safety of ACS is lacking for diabetic pregnant women at risk of preterm birth and those undergoing elective late-preterm CS, though this does not necessarily recommend against their use in diabetic women. While evidence remains inconclusive for women with growth-restricted preterm neonates, ACS appears to benefit preterm neonates delivered by women with chorioamnionitis. High-quality studies on maternal and long-term child outcomes in more diverse settings are needed to establish the balance of potential harms versus benefits in using ACS for these understudied subgroups.
Highlights
This study synthesizes available evidence on antenatal corticosteroids (ACS) use among special subgroups of women at risk of imminent preterm birth, including those (1) with pregestational and gestational diabetes mellitus, (2) undergoing elective caesarean section (CS) in late preterm (34 to
No eligible studies were identified for ACS use in diabetic pregnant women or those undergoing elective CS at late preterm
The findings of this review further highlight the dearth of research on the effectiveness and safety of ACS for diabetic mothers at risk of imminent preterm birth and for women undergoing elective caesarean birth in late preterm, for which direct evidence is lacking
Summary
The highlighted gaps in the evidence base demand an examination of the implications of using or not using ACS in cases of imminent preterm birth in these subgroups of women. As part of efforts to complement the evidence base preparation for the World Health Organization (WHO) recommendations on interventions to improve preterm birth outcomes [34], we performed a systematic review to assess the effects on maternal and child outcomes of ACS administration in four less common but important populations of pregnant women at risk of imminent preterm birth. For the newborn and child outcomes, the following were outcomes of interest for the review: neonatal mortality, perinatal mortality, RDS, surfactant use, intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), neonatal sepsis, NEC, mechanical ventilation use and duration, patent ductus arteriosus (PDA), chronic lung disease (CLD), bronchoplumonary dysplasia (BPD), Apgar scores, low birth weight, neurodevelopment, and anthropomentric status
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