American journal of perinatology最新文献

{"title":"Characteristics and Categories of Fetal Heart Rate Tracings and Adverse Neonatal Outcomes at Term.","authors":"Rachel L Wiley, Aaron W Roberts, Kristen A Cagino, Fabrizio Zullo, Hector Mendez-Figueroa, Suneet P Chauhan","doi":"10.1055/a-2708-4947","DOIUrl":"10.1055/a-2708-4947","url":null,"abstract":"<p><p>This study aimed to compare characteristics and categories of fetal heart rate tracings (FHRT) among term (≥37.0 weeks) singletons without versus with composite adverse neonatal outcomes (CANO).For 15 consecutive months, retrospectively FHRT of all deliveries were characterized by obstetricians, who were blinded to maternal characteristics, intrapartum course, and neonatal outcomes. The inclusion criteria were nonanomalous singletons at term, who labored and had at least 20 minutes of FHRT. CANO included any of the following: Apgar score < 7 at 5 minutes, mechanical ventilation for > 6 hours, hypoxic ischemic encephalopathy, seizure, sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing, enterocolitis, birth injury, meconium aspiration syndrome, or neonatal death. Positive likelihood ratios (PLR), with pre- and posttest probabilities, were calculated.Of the 5,160 deliveries during the study period, 3,166 (61.4%) met inclusion criteria, and 2,765 (87.3%) had between 20 and 120 minutes of FHRT reviewed. CANO occurred in 49 (1.5%) of the newborns. Three FHRT characteristics differed significantly among those without and with CANO-severe decelerations, tachycardia with any decelerations, or with severe decelerations. The PLR ranged from 1.60 to 5.96 for CANO, with posttest probabilities of CANO from 2.4 to 8.3%. Persistent category I within 20 to 120 minutes of delivery occurred with similar frequency among those without versus with CANO (11.5 vs. 8.2%; <i>p</i> = 0.472; PLR: 0.71). Presence of category II anytime occurred similarly for those without and with CANO (88.5 vs. 89.8%; <i>p</i> = 0.785; PLR: 1.01); category III, at any time, also occurred similarly in the two groups (0.8 vs. 2.0%; <i>p</i> = 0.319; PLR: 2.65).In our cohorts of term singletons, neither the characteristics nor the category of FHRT provided clinically meaningful discriminative capacity between newborns with versus without CANO. · Category I FHRT in approximately 10% of parturients.. · At term, CANO in 1.5%.. · Characteristics of FHRT: poor diagnostic tests for CANO.. · Categories I, II, and III: similar frequencies with and without CANO..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Maternal Obesity on Neonatal TSH Levels: A Prospective Study on the Influence of BMI.","authors":"Gökçe Çıplak, Gülsüm Kadıoğlu Şimşek, Özhan Akyol, Aylin Kayalı Akyol, Hayriye Gözde Kanmaz Kutman, Fuat Emre Canpolat","doi":"10.1055/a-2708-5136","DOIUrl":"https://doi.org/10.1055/a-2708-5136","url":null,"abstract":"<p><p>Thyroid hormones are crucial for fetal growth, especially the development of the central nervous system. The impact of maternal obesity on neonatal thyroid-stimulating hormone (TSH) levels, however, remains underexplored. This study aimed to evaluate the influence of maternal body mass index (BMI) on neonatal TSH (nTSH) levels.A prospective observational study was conducted involving 934 newborns with a gestational age greater than 35 weeks, born between July 2021 and January 2022. nTSH levels were measured from capillary blood samples obtained during routine congenital hypothyroidism screening. Maternal data, including age, pre-pregnancy BMI, weight gain during pregnancy, and thyroid function, were collected.The mean maternal BMI was 24 ± 4 kg/m², and the mean nTSH level was 2 ± 2.7 mIU/L. No significant difference in nTSH levels was observed between infants of mothers with BMI ≥25 and BMI <25 (<i>p</i> = 0.069). When mothers were categorized into five BMI groups, the only significant difference observed between the groups was in weight gain during pregnancy (<i>p</i> = 0.001). Additionally, a positive correlation between maternal BMI and neonatal birth weight, height, and head circumference was observed. A weak positive correlation between maternal weight gain and nTSH levels (<i>r</i> = 0.204, <i>p</i> = 0.001) was also noted.Our study indicates a potential relationship between maternal obesity and nTSH levels, suggesting that maternal BMI may influence neonatal thyroid function. · There is a potential relationship between maternal obesity and neonatal TSH levels.. · Maternal BMI and weight gain might influence neonatal thyroid function.. · The study emphasizes the need for close monitoring of pregnant women with obesity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Clinicians' Roles and Postpartum Opioid Pain Management: A Qualitative Analysis.","authors":"Tazim Merchant, Julia D DiTosto, Elizabeth Soyemi, Lynn M Yee, Nevert Badreldin","doi":"10.1055/a-2704-7765","DOIUrl":"https://doi.org/10.1055/a-2704-7765","url":null,"abstract":"<p><p>Pain is a common postpartum complaint, yet data suggest that approaches to postpartum pain management vary widely. Given the goal of improving quality and equity in postpartum pain management, we aimed to examine whether and how clinicians' perspectives on postpartum pain management differed by clinician roles.This is a qualitative study at a large, tertiary, and academic medical center. From November 2021 to June 2022, obstetric clinicians, including attending physicians, trainee physicians, and advanced practice providers (APPs), were recruited to complete in-depth interviews regarding their clinical experience managing postpartum pain using a semi-structured interview guide. Participants were asked to reflect both on their own role and that of the other clinician types. Purposive sampling was used to enroll a cohort representative of the institutional workforce in terms of clinician type and demographics. Data were analyzed using the constant comparative method.Of 46 participants, 47.8% (<i>n</i> = 22) were attending physicians, and 91% (<i>n</i> = 42) were female. Emergent themes were both self-reflected and externally directed. Data demonstrated that postpartum pain management differs by clinician type and level of experience. Themes related to the role of attending physicians included responsibilities as teachers for trainees, supervisory roles, and perceptions that attendings have greater comfort with prescribing opioids. Themes related to the role of trainee physicians included the impact of patient load on trainees' management, limitations of morning rounds, familiarity with emerging data, and perceptions of hesitancy to prescribe opioids. Themes related to the role of APPs included less reliance on opioids for postpartum pain management and emphasis on nonpharmacological approaches.Perspectives on postpartum pain management vary by clinician role. Consideration of these differences and the interplay between roles is essential when examining opioid prescribing patterns and developing interventions to improve postpartum pain management. · Pain management differs by role and experience.. · Attendings have more comfort with opioid prescriptions.. · Trainees are perceived as more hesitant to prescribe opioids.. · APPs rely more on nonopioid management strategies..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Continuous Neuromuscular Blockade in a Cohort of Patients with Evolving or Grade 3 Bronchopulmonary Dysplasia.","authors":"Anna Cosnahan, Farida A Farraj, Joanna Mitchell, Sarah E Bauer, Steven Conlon, Rebecca Rose","doi":"10.1055/a-2706-5861","DOIUrl":"https://doi.org/10.1055/a-2706-5861","url":null,"abstract":"<p><p>This study aimed to describe the use of continuous neuromuscular blockade (NMBA) in patients with life-threatening hypoxia and/or hypercarbia secondary to evolving or grade 3 bronchopulmonary dysplasia (BPD) and its association with short-term death, as well as clinical measures of respiratory severity.We identified a cohort of patients with evolving or grade 3 BPD at Riley Children's Health who received continuous infusion vecuronium for greater than 48 hours. We analyzed data using descriptive and inferential statistics.Of the 18 patients identified, 77% survived beyond 7 days after discontinuation of a single course of continuous vecuronium. All but one patient demonstrated decreased respiratory severity score (RSS) and oxygenation saturation index (OSI) across the period of NMBA administration. Mean RSS and OSI decreased significantly across the time of administration (<i>p</i> = 0.003) and was higher in the group that died versus the group that survived (<i>p</i> < 0.001, <i>p</i> = 0.001). Of those that survived to discharge, six received a tracheostomy, and one was discharged in room air.A majority of a cohort of patients with life threatening hypoxia and/or hypercarbia and evolving or grade 3 BPD exposed to continuous NMBA demonstrated a clinically significant incidence of short-term survival and reduced respiratory severity. · Evidence for NMBA use in BPD is limited.. · Unstable gas exchange on high BPD ventilator settings may necessitate NMBA use.. · NMBA use may decrease respiratory support needed and improve clinical stability in unstable BPD patients..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chlorothiazide is associated with a weaker diuretic response than furosemide in infants with bronchopulmonary dysplasia (BPD).","authors":"Timothy Nelin, Matthew Huber, Heidi Morris, Erik A Jensen, Kathleen Gibbs, Sara Bonamo DeMauro, Avery Zierk, Nicolas Goldstein Novick, David Rub, Anna O'Brien, Scott A Lorch, Nicolas Bamat","doi":"10.1055/a-2714-3368","DOIUrl":"https://doi.org/10.1055/a-2714-3368","url":null,"abstract":"<p><strong>Objective: </strong>To compare the acute diuretic effect of furosemide versus chlorothiazide in preterm infants with high-grade bronchopulmonary dysplasia (BPD).</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of infants with grade 2 or 3 BPD admitted to a level IV NICU between 36 and 60 weeks' postmenstrual age. Novel diuretic exposures were defined as administration of furosemide or chlorothiazide without prior exposure to the same agent in the preceding 7 days. The primary outcome was the within-subject change in net fluid balance (mL/kg) in the 24 hours before and after diuretic initiation. Multivariable linear regression adjusted for diuretic dosing, route, frequency, and clinical covariates.</p><p><strong>Results: </strong>Among 300 infants contributing 136 furosemide and 215 chlorothiazide exposures, furosemide was most often dosed every 24 hours (73%) and chlorothiazide every 12 hours (90%). After covariate adjustment, furosemide was associated with a threefold greater reduction in net fluid balance compared to chlorothiazide (-32.0 mL/kg vs. -10.5 mL/kg; p < 0.001). More frequent dosing (every 12 hours) was associated with greater diuretic effect than every 24-hour dosing for both agents (-22.4 vs. -11.3 mL/kg; p = 0.032). Concomitant use of both agents was common, yet the order of administration did not significantly influence fluid balance. No other clinical or biochemical characteristics were significantly associated with diuretic response.</p><p><strong>Conclusion: </strong>Furosemide has a significantly greater acute diuretic effect than chlorothiazide in infants with high-grade BPD. These findings may inform short-term fluid management strategies and support further investigation into optimal diuretic selection and dosing in this population.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Variation in Cerebral Near Infrared Spectroscopy Accuracy Among Infants in a Cardiac Intensive Care Unit.","authors":"Callie Marshall, Stephanie Diggs, Morgan Pfeiffer, Anna Gerst, Alexa Brumfiel, Zachary A Vesoulis","doi":"10.1055/a-2714-3293","DOIUrl":"https://doi.org/10.1055/a-2714-3293","url":null,"abstract":"<p><strong>Objective: </strong>Pulse oximeters overestimate arterial oxygen saturations in black versus white adults, children, and infants. While race's impact on near-infrared spectroscopy (NIRS) accuracy is less studied, some adult research suggests decreased accuracy in black patients. This study investigates the effect of race on NIRS accuracy in infants in a cardiac intensive care unit (CICU).</p><p><strong>Study design: </strong>A retrospective chart review was conducted for infants admitted to St. Louis Children's Hospital CICU from 2017-2023. Bland-Altman plots, Pearson correlations, and mean biases were analyzed.</p><p><strong>Result: </strong>254 infants (13% Black, 87% White) provided 3,687 central venous oxygen saturation (ScvO₂)-cerebral regional oxygen saturation (rScO₂) pairs. Measurement bias was -3.2% in Black infants and +0.1% in White infants (p<0.01).</p><p><strong>Conclusion: </strong>Cerebral NIRS underestimates ScvO₂ in Black infants but maintains negligible measurement bias in White infants. This is the first study to assess race and NIRS accuracy in infants; the difference is statistically significant but not clinically relevant in most contexts.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Yield of Amnioinfusion in the Prevention of Postpartum Hemorrhage.","authors":"Keren Zloto, Eyal Sivan, Rakefet Yoeli-Ullman, Shali Mazaki-Tovi, Suneet P Chauhan, Michal Fishel Bartal","doi":"10.1055/a-2535-8109","DOIUrl":"10.1055/a-2535-8109","url":null,"abstract":"<p><p>Although amnioinfusion decreases the rate of uterine atony, its effect on postpartum hemorrhage (PPH) is uncertain. This study aimed to assess whether amnioinfusion reduces the risk of PPH in laboring individuals.A retrospective study of all laboring singletons at a tertiary center between January 2013 and December 2022 at ≥34 weeks. Individuals with known major fetal anomalies, stillbirths, or missing delivery records were excluded. The primary outcome was PPH. Neonatal and secondary maternal outcomes were also explored. Adjusted odds ratios (aOR) were estimated using multivariable regression models.Out of 113,816 deliveries during the study period, 83,152 (77.1%) met inclusion criteria, and among them 4,597 (4.03%) had amnioinfusion. Laboring individuals with amnioinfusion were more commonly nulliparous, had more polyhydramnios, oligohydramnios, preeclampsia, gestational diabetes, and fetal growth restriction. Furthermore, individuals with amnioinfusion had a higher rate of labor induction (54.54 vs. 27.8%; <i>p</i> < 0.01) and a higher cesarean rate (36.9 vs. 9.5%; <i>p</i> < 0.01). Following multivariable regression, there was no significant difference in the rate of PPH among individuals who had an amnioinfusion (2.6%) versus those who did not (3.1%; aOR: 0.95, 95% confidence interval [CI]: 0.87, 1.27). The rates of endometritis (aOR: 1.4; 95% CI: 1.04-1.89) and postpartum fever (aOR: 1.70; 95% CI: 1.36-2.12) were higher in those who had amnioinfusion compared with those that did not.Among laboring individuals ≥ 34 weeks, intrapartum amnioinfusion was not associated with a reduction in the rate of PPH and was associated with a higher likelihood of infectious morbidity. · PPH stands as the foremost contributor to maternal mortality.. · There is limited information regarding the yield of amnioinfusion in the reduction of PPH.. · We evaluate whether amnioinfusion reduces the rate of PPH in laboring individuals ≥ 34 weeks..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1771-1777"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needs of Parents and Neonates in the Intensive Care Unit: A Literature Review.","authors":"Brandon W Qualls","doi":"10.1055/a-2552-9008","DOIUrl":"10.1055/a-2552-9008","url":null,"abstract":"<p><p>The admission of a neonate to the neonatal intensive care unit (NICU) presents unique and complex needs for both the infant and their parents. This literature review aims to synthesize existing research to comprehensively understand these needs, focusing on parental psychosocial well-being, practical requirements, and the neonate's developmental necessities. Understanding these needs is crucial for optimizing clinical outcomes and fostering healthy parent-infant relationships. A nonsystematic literature review was conducted using PubMed, Google Scholar, and PsycINFO databases. Search criteria focused on \"neonatal intensive care\" and \"parental needs.\" Articles published in English between 2011 and 2022 were included. The review analyzed 123 articles, primarily focusing on research conducted in Western countries. Parental needs were categorized into seven areas: mental health/psychosocial well-being, practical needs (physical, safety, monetary), parental involvement, relationships (infant, staff, peers), information, spiritual needs, and help with other responsibilities. Neonatal needs included parental involvement, skin-to-skin contact, breastfeeding, and reduced length of stay. Key findings highlighted the prevalence of parental anxiety and depression, the importance of practical support, and the critical role of parental involvement in both parent and infant well-being. This review underscores the interconnectedness of parental and neonatal needs within the NICU environment. Parental involvement is essential for both groups, and factors such as hospital policies, community resources, and socioeconomic status significantly influence fulfilling these needs. The limitation of the review indicates the need for more diverse global research. Future studies should address these limitations and explore effective interventions to meet the identified needs, improving outcomes for NICU families. · The review identifies seven key parental needs in the NICU and four neonatal needs.. · It is important to provide support for the well-being of both parents and infants.. · Hospital policies, community resources, and socioeconomic status impact the ability to meet these..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1825-1835"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumonia Vaccines: Indications for Use and Current Safety Data in Pregnancy.","authors":"Karley Dutra, Hayley Berry, Gweneth B Lazenby","doi":"10.1055/a-2505-5434","DOIUrl":"10.1055/a-2505-5434","url":null,"abstract":"<p><p><i>Streptococcus pneumoniae</i> is a leading cause of pneumonia, meningitis, and invasive pneumococcal disease among adults in the United States, with higher rates of disease occurring among individuals with chronic medical and immunocompromising conditions. Pregnant individuals, especially those with comorbid conditions, are also at increased risk of infection due to <i>S. pneumoniae</i> due to physiological and immunologic changes in pregnancy. Vaccination against pneumococcus is recommended for adults living with HIV aged 19 to 49, congenital or acquired immunodeficiency, asplenia, chronic renal failure, sickle cell disease, alcohol abuse, cerebrospinal fluid leaks, congestive heart failure and cardiomyopathies, chronic lung disease, chronic liver disease, and diabetes mellitus. During pregnancy, the American College of Obstetricians and Gynecologists (ACOG) recommends vaccination against <i>S. pneumoniae</i> for individuals meeting the criteria for immunization outside of pregnancy. Pneumococcal vaccine uptake has been low. There are no data available for vaccine uptake in pregnancy, but we suspect it is lower than nonpregnant populations. Low uptake of immunization rates in pregnancy is likely multifactorial and includes general vaccine hesitancy among pregnant individuals, cost, access to care, and supply shortages. While data in support of pneumococcal vaccines during pregnancy are limited, sufficient evidence exists to support the safety and efficacy of vaccination in the antepartum period. Pregnancy provides an opportunity to continuously engage individuals in care, allowing obstetricians and gynecologists to establish rapport, work to reduce vaccine hesitancy, and to provide pneumococcal immunization to those who are eligible. Medical indications for pneumococcal vaccination will increasingly apply to pregnant persons as the population acquires comorbidities and there is a need for improved education among obstetricians on the topic of antenatal pneumococcal vaccination. · Pregnant persons are at risk of S. pneumoniae.. · Adult pneumococcal vaccine uptake has been low.. · Obstetricians and gynecologists can benefit from education on pneumococcal vaccines.. · Encourage pneumococcal vaccines for eligible pregnant people..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1809-1818"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Preterm Antenatal Corticosteroids in Pregestational and Gestational Diabetic Pregnancies.","authors":"Lylach Haizler-Cohen, Maria C Alzamora, Nicole R Legro, Leila Eter, Tasha Freed, Suditi Rahematpura, Ayah Arafat, Victoria Greenberg, Sara N Iqbal","doi":"10.1055/a-2624-8405","DOIUrl":"10.1055/a-2624-8405","url":null,"abstract":"<p><p>This study aims to evaluate the association between late preterm antenatal corticosteroids (ACS) administration and the incidence of hypoglycemia and respiratory complications in neonates born to individuals with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM).Multi-center retrospective cohort study between 2016 and 2022. Pregnant people with PGDM or GDM who presented in the late preterm period with concern for preterm delivery were included. The indication for admission was classified as preterm labor, preterm prelabor rupture of membranes, poorly controlled diabetes, or other maternal/fetal indications. Exclusion criteria included multifetal gestations, fetal anomalies, stillbirths, prior course of ACS, or no anticipation for delivery in the next 7 days. The primary outcome was neonatal hypoglycemia. Secondary outcomes included composite respiratory morbidity, composite nonrespiratory morbidity, neonatal intensive care unit (NICU) admission, length of NICU stay, and neonatal death. Multivariable regression models were used to calculate the odds ratio and 95% confidence intervals for the outcomes after adjusting for an indication for admission, gestational age at delivery, and neonatal birth weight. Outcome data were then stratified by diabetes type (PGDM vs. GDM) and completion status of the ACS course (partial vs. complete). For PGDM pregnancies, outcome data were additionally stratified by glycemic control.In the study period, 453 patients (126 with PGDM and 327 with GDM) were included. Of those, 265 (58.5%) received ACS, and 188 (41.5%) did not. There were no significant differences in neonatal hypoglycemia and composite respiratory morbidity between the ACS and non-ACS groups, including in the subgroup analysis of PGDM and GDM pregnancies. However, late preterm ACS was associated with reductions in supplemental oxygen use, mechanical ventilation, and respiratory distress syndrome when a complete course of ACS was administered. In PGDM pregnancies, neonatal outcomes did not differ between the ACS and non-ACS groups, regardless of glycemic control.Late preterm ACS administration in diabetic pregnancies was not associated with increased neonatal hypoglycemia or improvements in composite respiratory morbidity. · Late preterm steroids in diabetic pregnancies are not associated with neonatal hypoglycemia.. · Composite respiratory morbidity is not improved in this setting.. · Glycemic control does not impact neonatal outcomes with late preterm steroid use..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1798-1808"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}