421 - Antenatal corticosteroids for reducing adverse maternal and child outcomes in special population of women at risk of imminent preterm birth: a systematic review and meta-analysis

Poster Number: 421
Publication Number: 421.223

Kana Saito, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Etsuko Nishimura, St.Luke's international university, Toda, Saitama, Japan; Toshiyuki Swa, Osaka University, Toyonaka, Osaka, Japan; Fumihiko Namba, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Jenny Cao, Burnet Institute, Lalor, Victoria, Australia; Jenny A. Ramson, Burnet Institute, Melbourne, Kalaru, New South Wales, Australia; Erika Ota, St.Luke‘s international university, Chuoku, Tokyo, Japan

Background: Antenatal corticosteroid (ACS) use is standard practice for imminent preterm birth at 24-34 weeks. However, ACS use for women with certain conditions remains controversial and these groups have frequently been excluded from clinical trials. The lack of consistent, evidence-based consensus has been a significant barrier to effective clinical management.

Objective: This study aims to synthesize available evidence on ACS use among groups of women at risk of imminent preterm birth including those: with pregestational or gestational diabetes; undergoing elective caesarean section (CS) in the late preterm; with chorioamnionitis; and with fetal growth restriction (FGR).

Design/Methods: A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science and Global Index Medicus was conducted for all comparative studies. Two reviewers independently determined study eligibility, extracted data, and assessed study quality (RoBANS). Aggregate odds ratios (ORs), relative ratios (RRs) and mean differences with 95% confidence intervals were estimated.

Results: All included articles were observational studies. Among women with pregestational or gestational diabetes (5 studies, Nf10,168 infants), the risk of NICU admission is possibly increased (2,262 infants, OR: 7.4, 95% CI: 5.04-10.89, low certainty evidence); evidence for other outcomes was very low certainty. Among women undergoing elective CS in late preterm (2 studies, Nf205 infants), data were available for 11 outcomes, but the evidence was very low certainty. Among women with chorioamnionitis (8 studies, Nf1,460 infants), outcome data for histological or clinical chorioamnionitis were very low certainty for all reported outcomes. Among women with FGR (18 studies, Nf8,988 infants), ACS use was associated with a possible reduction in severe interventricular hemorrhage (4,636 infants, OR: 0.54, 95%CI:0.43-0.68) and duration of hospital stay (396 infants, MD: -2.23, 95%CI:-3.18 to -0.83). The risk of pregnancy-induced hypertension (775 infants, OR: 1.47, 95% CI:1.07-2.01) and neonatal hypoglycemia (329 infants, OR: 2.06, 95% CI:1.27-3.32) was possibly increased.Conclusion(s): Direct evidence on the effectiveness and safety of ACS use is lacking for diabetic women at risk of preterm birth, women undergoing elective late preterm CS, and women with chorioamnionitis. ACS appears to benefit pregnancies with FGR. High-quality studies with adequate follow-up for long-term child outcomes are required to assess the benefits and risks of ACS use in these subgroups.
Fig1. Severe neonatal intraventricular hemorrhage in women with FGR
Fig2. Duration of neonatal hospital stay in women with FGR