Association of Antenatal Dexamethasone with Maternal and Neonatal Outcomes in Late Preterm Labor in a Tertiary Hospital in Thailand: A Retrospective Cohort Study

Abstract

Objective: To study the association of antenatal intramuscular dexamethasone with maternal and neonatal outcomes in women presenting with late preterm labor Materials and Methods: A retrospective cohort study was performed in pregnant women who had labor pain with or without delivery during the 34 0/7 to 36 6/7 weeks of gestation and admitted in Sunpasitthiprasong Hospital, Ubonratchathani, Thailand between 2016 and 2019. The clinical data such as maternal age, gestational age, gravidity, comorbidities, obstetric complications, dexamethasone, tocolytics, antibiotics administration, and delivery outcomes were recorded. The primary outcome was neonatal composite respiratory complications, defined as having any of respiratory distress, pneumonia, apnea, transient tachypnea of newborn, and bronchopulmonary dysplasia. The secondary outcome was invasive respiratory support including endotracheal intubation and continuous positive airway pressure use. Associations of dexamethasone with primary and secondary outcomes were examined using univariate and multivariate logistic regression. Results: Among 1,978 pregnant women and 2,089 neonates in the present study cohort study, they had median gestational age of 35 weeks 5 days at the time of presentation with preterm labor. Seven hundred and eighty (39.4%) pregnant women received dexamethasone. Nine hundred and forty neonates (45.1%) had composite respiratory complications. The neonates who received antenatal dexamethasone had an increased risk of composite respiratory complications (adjusted odd ratio [OR] 1.275, 95% confidence interval [CI] 1.018 to 1.598) without a significant increased risk of invasive respiratory support (adjusted OR 1.132, 95% CI 0.839 to 1.527). Other factor associated with significantly increased risk of composite respiratory complications was multifetal gestation. Conclusion: Antenatal dexamethasone administration in late preterm labor increased risk of composite respiratory complications. Keywords: Dexamethasone; Late preterm; Neonatal respiratory complications