Betamethasone Exposure and Neonatal Respiratory Morbidity Among Late Preterm Births by Planned Mode of Delivery and Gestational Age

Mark A Clapp; Siguo Li; Jessica L Cohen; Cynthia Gyamfi-Bannerman; Amy B Knudsen; Scott A Lorch; Tanayott Thaweethai; Jason D Wright; Anjali J Kaimal; Alexander Melamed

doi:10.1097/AOG.0000000000005756

Betamethasone Exposure and Neonatal Respiratory Morbidity Among Late Preterm Births by Planned Mode of Delivery and Gestational Age

Obstet Gynecol. 2024 Oct 10. doi: 10.1097/AOG.0000000000005756. Online ahead of print.

Authors

Mark A Clapp¹, Siguo Li, Jessica L Cohen, Cynthia Gyamfi-Bannerman, Amy B Knudsen, Scott A Lorch, Tanayott Thaweethai, Jason D Wright, Anjali J Kaimal, Alexander Melamed

Affiliation

¹ Department of Obstetrics, Gynecology, and Reproductive Biology, the Institute of Technology Assessment, Department of Radiology, and the Division of Biostatistics, Massachusetts General Hospital, and the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, California; the Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology, Columbia University, New York, New York; and the Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida.

PMID: 39388700
DOI: 10.1097/AOG.0000000000005756

Abstract

Objective: To estimate the effect of late preterm antenatal steroids on the risk of respiratory morbidity among subgroups of patients on the basis of the planned mode of delivery and gestational age at presentation.

Methods: This was a secondary analysis of the ALPS (Antenatal Late Preterm Steroid) Trial, a multicenter trial conducted within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network of individuals with singleton gestations and without preexisting diabetes who were at high risk for late preterm delivery (34-36 weeks of gestation). We fit binomial regression models to estimate the risk of respiratory morbidity, with and without steroid administration, by gestational age and planned mode of delivery at the time of presentation. We assumed a homogeneous effect of steroids on the log-odds scale, as was reported in the ALPS trial. The primary outcome was neonatal respiratory morbidity, as defined in the ALPS Trial.

Results: The analysis included 2,825 patients at risk for late preterm birth. The risk of respiratory morbidity varied significantly by planned mode of delivery (adjusted risk ratio [RR] 1.90, 95% CI, 1.55-2.33 for cesarean delivery vs vaginal delivery) and week of gestation at presentation (adjusted RR 0.56, 95% CI, 0.50-0.63). For those planning cesarean delivery and presenting in the 34th week of gestation, the risk of neonatal respiratory morbidity was 39.4% (95% CI, 30.8-47.9%) without steroids and 32.0% (95% CI, 24.6-39.4%) with steroids. In contrast, for patients presenting in the 36th week and planning vaginal delivery, the risk of neonatal respiratory morbidity was 6.9% (95% CI, 5.2-8.6%) without steroids and 5.6% (95% CI, 4.2-7.0%) with steroids.

Conclusion: The absolute risk difference of neonatal respiratory morbidity between those exposed and those unexposed to late preterm antenatal steroids varies considerably by gestational age at presentation and planned mode of delivery. Because only communicating the relative risk reduction of antenatal steroids for respiratory morbidity may lead to an inaccurate perception of benefit, more patient-specific estimates of risk expected with and without treatment may inform shared decision making.