Antenatal corticosteroids for late small-for-gestational-age fetuses

Area of Science:

• Obstetrics and Gynecology
• Neonatology
• Perinatology

Background:

• Late preterm infants (34-36 weeks) with small-for-gestational-age (SGA) fetuses are at increased risk for neonatal morbidity.
• Antenatal corticosteroids (ACS) are commonly used to promote fetal lung maturation, but their efficacy in SGA fetuses within this gestational window is debated.

Purpose of the Study:

• To evaluate the impact of antenatal corticosteroids (ACS) on neonatal morbidity in late preterm pregnancies complicated by small-for-gestational-age (SGA) fetuses.
• To compare composite neonatal outcomes between SGA fetuses exposed and not exposed to ACS.

Main Methods:

• Retrospective study of growth-restricted fetuses delivered between 34+0 and 36+6 weeks gestation.
• Primary composite outcome included respiratory support, respiratory distress syndrome, transient tachypnea, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal mortality.
• Multivariate analysis adjusted for gestational diabetes and delivery mode.

Main Results:

• The primary composite outcome was similar between ACS-exposed and unexposed groups (26.1% vs. 20.8%, p=0.512).
• Hypoglycemia was more frequent in neonates exposed to ACS (37.0% vs. 19.5%, p=0.037).
• Cesarean delivery was associated with increased risk of the primary outcome (OR=2.13, p=0.013).

Conclusions:

• Antenatal corticosteroids (ACS) did not demonstrate a significant reduction in neonatal morbidity for late preterm infants with small-for-gestational-age fetuses.
• Further research may be needed to identify specific subgroups that could benefit from ACS.
• The findings suggest that routine use of ACS in this population may not improve overall neonatal outcomes.