Evaluation of Hypoglycemia in Neonates of Women at Risk for Late Preterm Delivery: An Antenatal Late Preterm Steroids Trial Cohort Study

Author(s):  
Cynthia Gyamfi-Bannerman ◽  
Kathleen A. Jablonski ◽  
Sean C. Blackwell ◽  
Alan T. N. Tita ◽  
Uma M. Reddy ◽  
...  

Objective In the antenatal late preterm steroids (ALPS) trial betamethasone significantly decreased short-term neonatal respiratory morbidity but increased the risk of neonatal hypoglycemia, diagnosed only categorically (<40 mg/dL). We sought to better characterize the nature, duration, and treatment for hypoglycemia. Study Design Secondary analysis of infants from ALPS, a multicenter trial randomizing women at risk for late preterm delivery to betamethasone or placebo. This study was a reabstraction of all available charts from the parent trial, all of which were requested. Unreviewed charts included those lost to follow-up or from sites not participating in the reabstraction. Duration of hypoglycemia (<40 mg/dL), lowest value and treatment, if any, were assessed by group. Measures of association and regression models were used where appropriate. Results Of 2,831 randomized, 2,609 (92.2%) were included. There were 387 (29.3%) and 223 (17.3%) with hypoglycemia in the betamethasone and placebo groups, respectively (relative risk [RR]: 1.69, 95% confidence interval [CI]: 1.46–1.96). Hypoglycemia generally occurred in the first 24 hours in both groups: 374/385 (97.1%) in the betamethasone group and 214/222 (96.4%) in the placebo group (p = 0.63). Of 387 neonates with hypoglycemia in the betamethasone group, 132 (34.1%) received treatment, while 73/223 (32.7%) received treatment in placebo group (p = 0.73). The lowest recorded blood sugar was similar between groups. Most hypoglycemia resolved by 24 hours in both (93.0 vs. 89.3% in the betamethasone and placebo groups, respectively, p = 0.18). Among infants with hypoglycemia in the first 24 hours, the time to resolution was shorter in the betamethasone group (2.80 [interquartile range: 2.03–7.03) vs. 3.74 (interquartile range: 2.15–15.08) hours; p = 0.002]. Persistence for >72 hours was rare and similar in both groups, nine (2.4%, betamethasone) and four (1.9%, placebo, p = 0.18). Conclusion In this cohort, hypoglycemia was transient and most received no treatment, with a quicker resolution in the betamethasone group. Prolonged hypoglycemia was uncommon irrespective of steroid exposure. Key Points

2019 ◽  
Vol 173 (5) ◽  
pp. 462 ◽  
Author(s):  
Cynthia Gyamfi-Bannerman ◽  
John A. F. Zupancic ◽  
Grecio Sandoval ◽  
William A. Grobman ◽  
Sean C. Blackwell ◽  
...  

2016 ◽  
Vol 71 (8) ◽  
pp. 453-455 ◽  
Author(s):  
Cynthia Gyamfi-Bannerman ◽  
Elizabeth A. Thom ◽  
Sean C. Blackwell ◽  
Alan T. N. Tita ◽  
Uma M. Reddy ◽  
...  

2016 ◽  
Vol 374 (14) ◽  
pp. 1311-1320 ◽  
Author(s):  
Cynthia Gyamfi-Bannerman ◽  
Elizabeth A. Thom ◽  
Sean C. Blackwell ◽  
Alan T.N. Tita ◽  
Uma M. Reddy ◽  
...  

2017 ◽  
Vol 106 (10) ◽  
pp. 1708-1708 ◽  
Author(s):  
Hannah R. Canty ◽  
Stephanie Dukhovny ◽  
Jamie B. Warren

2019 ◽  
Vol 37 (04) ◽  
pp. 365-369
Author(s):  
Matthew J. Bicocca ◽  
Sean C. Blackwell ◽  
Baha M. Sibai

Abstract Objective We sought to determine if maternal prepregnancy body mass index (BMI) is a risk factor for neonatal respiratory morbidity and to determine if increasing BMI decreased the efficacy of betamethasone (BMZ). Study Design This was a secondary analysis of the Antenatal Late Preterm Steroids trial, double-blind, randomized controlled trial involving 2,831 women between 340/7 and 365/7 weeks who received BMZ or a matching placebo. We compared the rate of neonatal respiratory morbidity among prepregnancy BMI classes in both the placebo and treatment groups. We also stratified the treatment effect by maternal BMI at the time of delivery. Results A total of 2,822 women were identified with maternal weight recorded at delivery; 2,740 women also had self-reported prepregnancy weight available. When stratified by prepregnancy BMI class, there was no difference in neonatal respiratory morbidity in the BMZ or in placebo groups. When analyzed by BMI at delivery, there was no difference in the rate of neonatal respiratory morbidity, and BMI was not a predictor of treatment response (odds ratio = 1.00, 95% confidence interval = 0.99–1.02). Conclusion Maternal prepregnancy BMI is not associated with late preterm neonatal respiratory morbidity. Maternal obesity does not decrease the efficacy of BMZ for preventing late preterm neonatal respiratory morbidity.


2019 ◽  
Vol 220 (1) ◽  
pp. S310-S311
Author(s):  
Morgen S. Doty ◽  
Han-Yang Chen ◽  
Suneet P. Chauhan ◽  
Baha M. Sibai

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