(337) Late Preterm Steroids for those with Pregestational/ Early Gestational Diabetes and Risk of Neonatal Hypoglycemia

Objective: The ALPS trial showed reduced rate of neonatal respiratory complications with the use of late preterm steroids but excluded those with pregestational diabetes. We hypothesize that late preterm steroids given to those with pregestational and early gestational diabetes are associated with a higher risk of neonatal hypoglycemia (NNH) and lower risk of respiratory complications.

Study Design: This is a secondary analysis of MOMPOD, a multicenter, randomized controlled trial of 831 pregnant patients with preexisting type 2 diabetes or diabetes diagnosed prior to 23 weeks’ gestation that were treated with insulin alone or insulin and metformin. Patients who delivered 34-36 6/7 weeks were included. Those who received late preterm steroids were compared to those who did not have any exposure to antenatal steroids in pregnancy. The primary outcome was NNH (blood glucose < 40 mg/dl or need for IV dextrose treatment). Secondary outcomes included respiratory support in the NICU/ intermediate nursery, transient tachypnea of the newborn, and respiratory distress syndrome. Modified Poisson regression was performed to calculate the relative risk, adjusting for confounding variables.

Results:

Of the patients that delivered late preterm, 20 received late preterm steroids and 136 did not have any antenatal steroid exposure. NNH was present in 16 (80%) and 73 (54%) of those exposed to steroids vs no steroids. The adjusted relative risk for NNH was 1.63 (95% CI 1.23-2.16). 9 (45%) and 62 (46%) required respiratory support in the NICU during the first 30 days of life in the steroid and no steroid group, respectively. The adjusted relative risk for respiratory support in the NICU was 1.08 (95% CI 0.63-1.86).

Conclusion:

Administration of late preterm antenatal steroids in pregnancies complicated by pregestational diabetes and early gestational diabetes is associated with a 1.6 increased risk for neonatal hypoglycemia. However, the secondary analysis was not powered to evaluate for respiratory complications. Further studies are needed to understand the full spectrum of neonatal outcomes associated with this practice.