(844) Corticosteroid Impact on Umbilical Artery Dopplers in Fetal Growth Restriction Pregnancies: Systematic Review and Meta-Analysis

Objective: Current guidelines recommend the administration of antenatal corticosteroids (ACS) for pregnancies with fetal growth restriction (FGR) and abnormal umbilical artery Doppler (UAD) velocimetry. This systematic review examined the change in UAD after the administration of ACS in pregnancies complicated by FGR and any associations with perinatal outcomes.

Study Design: Seven electronic databases (PubMed, Cochrane Library, OVID Medline, Global Index Medicus, Scopus, Google Scholar and Embase) were searched from 1980 to May 2024 using MESH-terms for studies in English. Eligible studies provided a FGR definition and documentation of UAD prior to and after ACS administration. All studies were independently evaluated following PRISMA guidelines. Risk of bias was assessed via the ROBIN-I tool. Meta-analysis was conducted using the metafor package for R.

Results: A total of 13 studies were included with a total of 585 pregnancies. Six studies reported changes in end-diastolic flow (EDF) while 7 studies reported on pulsatility index (PI). Baseline PI decreased from 2.06 (95% CI, 1.63-2.49) to 1.78 (95% CI, 1.39-2.17) after administration of ACS, but subsequently returned to a baseline PI of 2.00 (95% CI, 1.56-2.43) at time of final Doppler evaluation. In studies evaluating EDF, 44% (95% CI, 33-55%) of patients showed improvement. Patients with improvement in EDF were found to have a lower rate of perinatal mortality compared to persistent absent or reversed EDF (6% vs. 12%).

Conclusion: Evidence suggests that UAD assessment after administration of ACS in fetuses with FGR may result in a transient change in UAD. Improvement of UAD after ACS may prognosticate more favorable perinatal outcomes. This systematic review and meta-analysis did highlight that the studies evaluating UAD changes in pregnancies affected by FGR are inconsistent in the metrics used to evaluate these changes. A set of standardized metrics is necessary for reporting ultrasound changes and perinatal outcomes in studies of Doppler changes following ACS in pregnancies affected by FGR.