P1.179: Betamethasone Use in Late Preterm Mothers: The Question of the Diabetic Mother

Background: The use of antenatal betamethasone for women at risk of late preterm delivery (34 to 36 weeks gestation) is an evolving area of perinatal care aimed at improving neonatal outcomes. Antenatal corticosteroids (ACS) are routinely administered to pregnant women at risk for early preterm delivery (before 34 weeks) due to strong evidence showing these steroids significantly reduce adverse neonatal outcomes such as respiratory distress syndrome (RDS) and intraventricular hemorrhage. Despite the American College of Obstetricians and Gynecologists' recommendation that pregnant women at risk of late preterm delivery should receive a course of ACS, the administration of these steroids after 34 weeks has been less common. This discrepancy is partly due to a perceived lack of data and belief that late preterm infants generally thrive without additional interventions. Contrary to this belief, late preterm infants face a higher risk of health complications and mortality than their full-term peers. Hesitancy also exists due to concerns about adverse effects, including hypoglycemia, particularly in infants of diabetic mothers (IDM). IDM are at increased risk of preterm birth as well as RDS, which raises the important question of if diabetic mothers at risk of late preterm delivery should receive antenatal steroids.

Methods: This study aimed to elucidate the risks and benefits of ACS administration for late preterm infants in the neonatal period, particularly for those born to diabetic mothers. We performed a retrospective cohort study of late preterm neonates (33-36 weeks gestation) born at a small county hospital to investigate differences in short-term outcomes based on administration of ACS. Over the course of 2 years, we reviewed 85 neonates, 30 of whom required respiratory support. Variables studied included presence of maternal diabetes, neonatal respiratory outcomes, and rates of neonatal hypoglycemia.

Results: The data demonstrated a statistically significant negative correlation between the number of doses of antenatal betamethasone received and the number of days required to wean to room air among infants who required respiratory support (p = 0.04). In our study, diabetic women were less likely than their non-diabetic peers to receive the recommended course of ACS (p = 0.004); however, there was no significant increase in hypoglycemia risk for late preterm infants whose mothers were diabetic (p = 0.525) or received antenatal steroids (p = 0.163).

Conclusion: The data suggest significant benefit exists for late preterm infants whose mothers receive ACS without an increased risk of neonatal hypoglycemia. Based on these findings, diabetic status should not preclude women at risk of late preterm delivery from receiving antenatal steroids. This study has influenced practice changes in the obstetrics department at the study site and contributes to a growing body of knowledge informing perinatal care and impacting outcomes for late preterm neonates.