Meeting paper
SMFM paper
Should patients with documented fetal lung immaturity after 34 weeks of gestation be treated with steroids?

Presented at the 32nd annual meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Feb. 6-11, 2012.
https://doi.org/10.1016/j.ajog.2012.06.019Get rights and content

Objective

The purpose of this study was to determine whether corticosteroid administration after 34 weeks of gestation is associated with improved neonatal outcome in the presence of fetal lung immaturity.

Study Design

We conducted a retrospective cohort study of women who underwent amniocentesis to determine fetal lung maturity from 34-37 weeks of gestation. Patients with negative results (167 women) received steroids based on physician preference and were categorized into 2 groups: study group treated with betamethasone (n = 83 women) and control group in which patients did not receive betamethasone therapy (n = 84 women). The 2 groups were compared with respect to neonatal outcomes. Composite neonatal morbidity was defined as the presence of respiratory distress syndrome, transient tachypnea of the newborn infant, or the need for respiratory support.

Results

The rate of composite neonatal morbidity was significantly lower among infants who were exposed to steroids compared with the control group (8.4% vs 21%; P = .02). Multiple regression analysis revealed that corticosteroid administration was associated independently with the composite morbidity outcome.

Conclusion

Antenatal steroid administration after 34 weeks of gestation is associated with improved neonatal outcome and should be considered when fetal lung immaturity is documented.

Section snippets

Materials and Methods

This is a retrospective cohort study of pregnant women who underwent amniocentesis to determine fetal lung maturity at 34-37 weeks of gestation. All women received prenatal care and delivered at a tertiary medical center between January 2006 and July 2011. The study was approved by the Institutional Research Ethics Board of Sheba Medical Center.

Fetal lung maturity was determined by fluorescence polarization (TDx-FLM II); a TDx-FLM-II test result of <50 mg/g was defined as an immature test.

Results

Of all the women who underwent amniocentesis for lung maturity during the study period, 167 had immature test results; 83 women were treated (study group) and 84 women were not treated (control group) with corticosteroids.

The major indications for amniocentesis and early delivery were distributed equally between the study and control groups and included bad obstetric history (20% vs 12%; P = .1), intrauterine growth restriction (16% vs 20%; P = .5), mild preeclampsia (13% vs 7%; P = .21),

Comment

Despite the increased neonatal mortality and morbidity rates that are associated with late preterm births, to date, no intervention has been shown to be valuable in improving neonatal outcome. It is against this background that treatment with corticosteroids therapy at >34 weeks of gestation was rekindled. However, a metaanalysis regarding the efficacy of steroids at >33 weeks of gestation has concluded that there is insufficient evidence to support the beneficial effect of antenatal

References (17)

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Cited by (0)

The authors report no conflict of interest.

The first 2 authors contributed equally to this work.

Cite this article as: Yinon Y, Haas J, Mazaki-Tovi S, et al. Should patients with documented fetal lung immaturity after 34 weeks of gestation be treated with steroids? Am J Obstet Gynecol 2012;207:222.e1-4.

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