Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

Tom Magutu, Mercer University College of Pharmacy

Late preterm infants are at higher risk for neonatal death and complications including respiratory disease than infants born at term. [1]

Antenatal corticosteroid therapy is indicated for women at risk of premature delivery and is stated to result in a substantial decrease in neonatal morbidity and mortality. [2]


 

Title: Antenatal Betamethasone for Women at Risk for Late Preterm Delivery
Design Randomized trial; N= 2,831
Objective To assess whether the administration of betamethasone to women who are likely to deliver in the late preterm period would decrease respiratory and other neonatal complications
Study Groups Women with a singleton pregnancy between 34 weeks and zero days to 36 weeks and five days of gestation with a high probability of delivery in the late preterm period were randomized to either the betamethasone group (n= 1,429) or the control group (n= 1,402).
Methods The betamethasone group received a course of two intramuscular injections containing 12 mg of betamethasone while the placebo group received a matching placebo administered 24 hours apart.  Research assistants abstracted information from maternal and neonatal charts.  Follow-up was performed at 28 days after birth for all infants who were receiving oxygen at the time of discharge.
Duration October 2010 to February 2015
Primary Outcome Measure Need for respiratory support within 72 hours after birth
Baseline Characteristics Characteristic, n (%) Betamethasone Control
Preterm labor with intact membranes 400 (28.0) 392 (28.0)
Ruptured membranes 316 (22.1) 304 (21.7)
Expected delivery for gestational hypertension or preeclampsia 370 (25.9) 385 (27.5)
Expected delivery for fetal growth restriction 46 (3.2) 48 (3.4)
Expected delivery for oligohydramnios 50 (3.5) 42 (3.0)
Expected delivery for other indication 247 (17.3) 231 (16.5)
Preeclampsia or gestational hypertension 433 (30.3) 440 (31.4)
Gestational diabetes 153 (10.7) 153 (10.9)
Maternal age, mean ± SD, year 28.6 ± 6.3 27.8 ± 6.1
Results   Betamethasone, n (%) Placebo,    n (%) Relative risk (95% CI) p value
Primary outcome 165 (11.6) 202 (14.4) 0.80 (0.66–0.97) 0.02
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions Administration of betamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications.

 

According to the study, the antenatal administration of betamethasone to women at risk for late preterm delivery decreased the need for substantial neonatal respiratory support during the first 72 hours after birth.  Treatment with betamethasone among patients undergoing a scheduled cesarean at term is the standard of care in the United Kingdom as result of similar findings from other studies.  The reduction in the rate of respiratory complications with betamethasone therapy could lead to benefit in long-term outcomes such as chronic lung disease, which can be an approach in future studies.

 

References

  1. Crowther CA, Harding JE. Antenatal Glucocorticoids for Late Preterm Birth?. N Engl J Med. 2016;374(14):1376-7.
  2. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. JAMA. 1995;273(5):413-8.
  3. Gyamfi-bannerman C, Thom EA, Blackwell SC, et al. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. N Engl J Med. 2016;

 

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