Abstract：
Unlike pregestational diabetes mellitus, the American College of Obstetricians and Gynecologists recommends antenatal corticosteroids in those with gestational diabetes mellitus at risk for preterm birth. However, this recommendation is based on limited data, only 10.6% of the Antenatal Late Preterm Steroids study sample had gestational diabetes mellitus. There is a paucity of data on the risk of neonatal respiratory and other morbidity in this population.
This study aimed to examine respiratory outcomes in parturients with gestational diabetes mellitus who received antenatal corticosteroids and delivered during the late preterm period vs those who did not.
This population-based cohort study used the US Vital Statistics dataset between 2016 to 2020. The inclusion criteria were singleton, nonanomalous individuals who delivered between 34.0 to 36.6 weeks with gestational diabetes mellitus and known status of antepartum corticosteroid exposure. The primary outcome, a composite neonatal adverse outcome, included Apgar score <5 at 5 minutes, immediate assisted ventilation, assisted ventilation >6 hours, surfactant use, seizure, or neonatal mortality. The secondary outcome was a composite maternal adverse outcome, including maternal blood transfusion, ruptured uterus, unplanned hysterectomy, and admission to the intensive care unit. Multivariable Poisson regression models were used to estimate adjusted relative risks and 95% confidence intervals. Average annual percent change was calculated to assess changes in rates of corticosteroid exposure over the study period.
Of 19 million births during the study period, 110,197 (0.6%) met the inclusion criteria, and among them, 23,028 (20.9%) individuals with gestational diabetes mellitus received antenatal corticosteroids. The rate of antenatal steroid exposure remained stable over the 5 years (APC=10.7; 95% confidence interval, -5.4 to 29.4). The composite neonatal adverse outcome was significantly higher among those who received corticosteroids than among those who did not (137.1 vs 216.5 per 1000 live births; adjusted relative risk 1.24; 95% confidence interval, 1.20-1.28). Three components of the composite neonatal adverse outcome-immediate assisted ventilation, intubation >6 hours, and surfactant use-were significantly higher with exposure than without. In addition, the composite maternal adverse outcome was significantly higher among those who received corticosteroids (adjusted relative risk, 1.34; 95% confidence interval, 1.18-1.52). Three components of the composite maternal adverse outcome-admission to intensive care unit, blood transfusion, and unplanned hysterectomy-were significantly higher among the exposed group. Subgroup analysis, among large for gestational age, by gestational age, and race and ethnicity, confirm the trend of increased likelihood of adverse outcomes with exposure to corticosteroid.
Individuals with gestational diabetes mellitus and antenatal corticosteroid exposure, who delivered in the late preterm, were at higher risk of neonatal and maternal adverse outcomes than those unexposed to corticosteroid.
This study aimed to examine respiratory outcomes in parturients with gestational diabetes mellitus who received antenatal corticosteroids and delivered during the late preterm period vs those who did not.
This population-based cohort study used the US Vital Statistics dataset between 2016 to 2020. The inclusion criteria were singleton, nonanomalous individuals who delivered between 34.0 to 36.6 weeks with gestational diabetes mellitus and known status of antepartum corticosteroid exposure. The primary outcome, a composite neonatal adverse outcome, included Apgar score <5 at 5 minutes, immediate assisted ventilation, assisted ventilation >6 hours, surfactant use, seizure, or neonatal mortality. The secondary outcome was a composite maternal adverse outcome, including maternal blood transfusion, ruptured uterus, unplanned hysterectomy, and admission to the intensive care unit. Multivariable Poisson regression models were used to estimate adjusted relative risks and 95% confidence intervals. Average annual percent change was calculated to assess changes in rates of corticosteroid exposure over the study period.
Of 19 million births during the study period, 110,197 (0.6%) met the inclusion criteria, and among them, 23,028 (20.9%) individuals with gestational diabetes mellitus received antenatal corticosteroids. The rate of antenatal steroid exposure remained stable over the 5 years (APC=10.7; 95% confidence interval, -5.4 to 29.4). The composite neonatal adverse outcome was significantly higher among those who received corticosteroids than among those who did not (137.1 vs 216.5 per 1000 live births; adjusted relative risk 1.24; 95% confidence interval, 1.20-1.28). Three components of the composite neonatal adverse outcome-immediate assisted ventilation, intubation >6 hours, and surfactant use-were significantly higher with exposure than without. In addition, the composite maternal adverse outcome was significantly higher among those who received corticosteroids (adjusted relative risk, 1.34; 95% confidence interval, 1.18-1.52). Three components of the composite maternal adverse outcome-admission to intensive care unit, blood transfusion, and unplanned hysterectomy-were significantly higher among the exposed group. Subgroup analysis, among large for gestational age, by gestational age, and race and ethnicity, confirm the trend of increased likelihood of adverse outcomes with exposure to corticosteroid.
Individuals with gestational diabetes mellitus and antenatal corticosteroid exposure, who delivered in the late preterm, were at higher risk of neonatal and maternal adverse outcomes than those unexposed to corticosteroid.
摘要：
背景：与孕前糖尿病不同，ACOG建议在有早产风险的GDM患者中使用产前皮质类固醇。然而,此建议基于有限的数据，只有10.6%的产前晚期早产类固醇(ALPS)研究样本有GDM。关于该人群中新生儿呼吸系统疾病和其他疾病风险的数据很少。
目的：研究GDM产妇在产前接受糖皮质激素并在早产后期分娩的呼吸结局与未接受糖皮质激素的比较。
方法：这项基于人群的队列研究使用了2016年至2020年的美国生命统计数据集。纳入标准是单例，在GDM治疗34.0至36.6周之间分娩且产前皮质类固醇暴露状态已知的非异常个体。主要结果，新生儿复合不良结局（CNAO），包括：阿普加5分钟得分<5，即时辅助通气,辅助通气>6小时，表面活性剂的使用，癫痫发作,或新生儿死亡率。次要结局是复合母体不良结局（CMAO），包括母体输血，子宫破裂,计划外子宫切除术,和入住重症监护病房(ICU)。多变量泊松回归模型用于估计调整后相对风险（aRR）和95％置信区间（CI）。计算平均年变化百分比（AAPC）以评估研究期间皮质类固醇暴露率的变化。
结果：研究期间有1900万婴儿出生，110,197（0.6%）符合纳入标准，其中,23,028例(20.9%)GDM患者在产前接受皮质类固醇治疗。产前类固醇暴露率在5年内保持稳定(APC=10.7,95%CI:-5.4,29.4)。在接受皮质类固醇治疗的患者中，CNAO明显高于未接受皮质类固醇治疗的患者（每1,000活产婴儿137.1和216.5；RR1.24，95％CI1.20-1.28）。CNAO即时辅助通气的三个组成部分，插管>6小时，和表面活性剂的使用-暴露时明显高于不暴露时。此外,在接受皮质类固醇治疗的患者中,CMAO显著增高(aRR1.34,95%CI1.18~1.52).CMAO的三个组成部分-入住ICU，输血,非计划子宫切除术-在暴露组中显著高于非计划子宫切除术.亚组分析,在胎龄较大的人群中，根据胎龄，种族和民族，确认皮质类固醇暴露导致不良结局可能性增加的趋势.
结论：GDM和产前皮质类固醇暴露者与未暴露者相比，在晚期早产分娩的新生儿和产妇不良结局的风险较高.
目的：研究GDM产妇在产前接受糖皮质激素并在早产后期分娩的呼吸结局与未接受糖皮质激素的比较。
方法：这项基于人群的队列研究使用了2016年至2020年的美国生命统计数据集。纳入标准是单例，在GDM治疗34.0至36.6周之间分娩且产前皮质类固醇暴露状态已知的非异常个体。主要结果，新生儿复合不良结局（CNAO），包括：阿普加5分钟得分<5，即时辅助通气,辅助通气>6小时，表面活性剂的使用，癫痫发作,或新生儿死亡率。次要结局是复合母体不良结局（CMAO），包括母体输血，子宫破裂,计划外子宫切除术,和入住重症监护病房(ICU)。多变量泊松回归模型用于估计调整后相对风险（aRR）和95％置信区间（CI）。计算平均年变化百分比（AAPC）以评估研究期间皮质类固醇暴露率的变化。
结果：研究期间有1900万婴儿出生，110,197（0.6%）符合纳入标准，其中,23,028例(20.9%)GDM患者在产前接受皮质类固醇治疗。产前类固醇暴露率在5年内保持稳定(APC=10.7,95%CI:-5.4,29.4)。在接受皮质类固醇治疗的患者中，CNAO明显高于未接受皮质类固醇治疗的患者（每1,000活产婴儿137.1和216.5；RR1.24，95％CI1.20-1.28）。CNAO即时辅助通气的三个组成部分，插管>6小时，和表面活性剂的使用-暴露时明显高于不暴露时。此外,在接受皮质类固醇治疗的患者中,CMAO显著增高(aRR1.34,95%CI1.18~1.52).CMAO的三个组成部分-入住ICU，输血,非计划子宫切除术-在暴露组中显著高于非计划子宫切除术.亚组分析,在胎龄较大的人群中，根据胎龄，种族和民族，确认皮质类固醇暴露导致不良结局可能性增加的趋势.
结论：GDM和产前皮质类固醇暴露者与未暴露者相比，在晚期早产分娩的新生儿和产妇不良结局的风险较高.
