Journal List > Korean J Obstet Gynecol > v.54(10) > 1088342

TOOLS
Jo, Kwak, Ji, Cha, Choi, Oh, Roh, and Kim: The effect of antenatal corticosteroid on incidence of respiratory distress syndrome according to maternal body mass index
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2011; 54(10): 582-590.

Published online: 19 October 2011

DOI: https://doi.org/10.5468/KJOG.2011.54.10.582

The effect of antenatal corticosteroid on incidence of respiratory distress syndrome according to maternal body mass index

Eun Ju Jo, MD, Hye-Min Kwak, MD, Hyun-Young Ji, MD, Hyun-Hwa Cha, MD, Suk-Joo Choi, MD, Soo-young Oh, MD, Cheong-Rae Roh, MD, Jong-Hwa Kim, MD

Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author: Suk-Joo Choi, MD. Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3546, Fax: +82-2-3410-0630, drmaxmix.choi@samsung.com

Received 25 May 2011       Revised 19 July 2011       Accepted 9 September 2011

Copyright © 2011. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To investigate the effects of antenatal corticosteroid (ACS) on incidence of neonatal respiratory distress syndrome (RDS) according to maternal body mass index (BMI).

Methods

We retrospectively reviewed the medical records of 715 singleton pregnant women who delivered between 24+0 and 34+0 weeks of gestation, from January 1996 to December 2006. Subjects were categorized into three groups according to ACS exposure: a nonuser group (n = 244), a single-course group (n = 377) and a multiple-course group (n = 94). Subjects were re-categorized into three groups according to maternal BMI at admission: group 1 (BMI < 23.0 kg/m2, n = 234), group 2 (BMI 23.0-24.9 kg/m2, n = 166) and group 3 (BMI ≥ 25.0 kg/m2, n = 315). Univariate and multiple logistic regression analyses were used for the statistical analysis.

Results

Overall, the incidence of RDS was significantly lower in ACS-user groups than the non-user group, with lowest incidence in the multiple-course group (non-user vs. single-course vs. multiple-course: 44.3% vs. 41.1% vs. 11.7%, P < 0.001). The incidence of RDS was not different among the three BMI groups. Multiple logistic regression analysis showed that single- and multiple-course of ACS was significantly associated with reduced incidence of RDS: single-course, odds ratio (OR) 0.593, 95% confidence interval (CI) 0.373, 0.942; multiple-course, OR 0.085, 95% CI 0.034, 0.213. However, maternal BMI was not associated with reduced incidence of RDS with different ACS-courses (P for interaction = 0.690).

Conclusion

ACS therapy, especially when multiple-course was used, was significantly associated with reduced incidence of RDS, but maternal BMI did not influence its effectiveness.

Keywords: Preterm delivery, Antenatal corticosteroid, Respiratory distress syndrome, Maternal body mass index

Figures and Tables

Table 1
Demographic characteristics of the patients and pregnancy outcomes according to antenatal steroid exposure
kjog-54-582-i001

Bolding denotes significant findings.

Data are presented by mean ± standard deviation or number (%) or median [range].

PTL, preterm labor; IIOC, incompetent internal os of cervix; PPROM, preterm premature rupture of membranes; DM, diabetes mellitus; ACS, antenatal corticosteroid.

aJonckheere-Terpstra test, P < 0.001.

bnon-user vs. multiple-course, P < 0.05; single-course vs. multiple-course, P < 0.05.

cgestational hypertension, mild & severe preeclampsia, superimposed preeclampsia, eclampsia, chronic hypertension.

Table 2
Perinatal outcomes of the preterm neonates according to antenatal steroid exposure
kjog-54-582-i002

Bolding denotes significant findings.

Data are presented by mean ± standard deviation or number (%) or median [range].

SGA, small-for-gestational-age; NICU, neonatal intensive care unit.

aNon-user vs. multiple-course, P < 0.05; single-course vs. multiple-course, P < 0.05.

bDefined as having more than one of the following: neonatal death, respiratory distress syndrome, bronchopulmonary dysplasia, periventricular leukomalacia, intraventricular hemorrhage (≥ grade 3), retinopathy of prematurity (≥ grade 3), necrotizing enterocolitis (≥ stage 2), suspected or proven early and late neonatal sepsis.

Table 3
Demographic characteristics of the patients and pregnancy outcomes according to maternal body mass index
kjog-54-582-i003

Bolding denotes significant findings.

Data are presented by mean ± standard deviation or number (%) or median [range].

PTL, preterm labor; IIOC, incompetent internal os of cervix; PPROM, preterm premature rupture of membranes; ACS, antenatal corticosteroid; DM, diabetes mellitus.

aJonckheere-Terpstra test, P < 0.05.

bNon-user vs. multiple-course, P < 0.05.

cGestational hypertension, mild & severe preeclampsia, superimposed preeclampsia, eclampsia, chronic hypertension.

Table 4
Perinatal outcomes of the preterm neonates according to maternal body mass index
kjog-54-582-i004

Bolding denotes significant findings.

Data are presented by mean ± standard deviation or number (%) or median [range].

SGA, small-for-gestational-age; NICU, neonatal intensive care unit.

aJonckheere-Terpstra test, P < 0.05.

bDefined as having more than one of the following: neonatal death, respiratory distress syndrome, bronchopulmonary dysplasia, periventricular leukomalacia, intraventricular hemorrhage (≥ grade 3), retinopathy of prematurity (≥ grade 3), necrotizing enterocolitis (≥ stage 2), suspected or proven early and late neonatal sepsis.

Table 5
Incidence of respiratory distress syndrome and composite morbidity according to maternal body mass index and antenatal steroid exposure
kjog-54-582-i005

Bolding denotes significant findings.

RDS; respiratory distress syndrome,, BMI; body mass index

Table 6
Relationship between the incidence of respiratory distress syndrome and independent variables analyzed by multiple logistic regression
kjog-54-582-i006

Bolding denotes significant findings.

OR; odds ratio, CI; confidence interval, BMI; body mass index, ACS; antenatal corticosteroid.

References

1. Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972. 50:515–525.
2. Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994. Am J Obstet Gynecol. 1995. 173:322–335.
3. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consens Statement. 1994. 12:1–24.
4. ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 475: Antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2011. 117:422–424.
5. Ballabh P, Lo ES, Kumari J, Cooper TB, Zervoudakis I, Auld PA, et al. Pharmacokinetics of betamethasone in twin and singleton pregnancy. Clin Pharmacol Ther. 2002. 71:39–45.
6. Cho HJ, Seo ES, Song SE, Jung KL, Choi SJ, Oh SY, et al. The effect of multiple courses of antenatal corticosteroid therapy on perinatal outcome of the preterm neonates. Korean J Obstet Gynecol. 2007. 50:741–750.
7. Choi SJ, Song SE, Seo ES, Oh SY, Kim JH, Roh CR. The effect of single or multiple courses of antenatal corticosteroid therapy on neonatal respiratory distress syndrome in singleton versus twin pregnancies. Aust N Z J Obstet Gynaecol. 2009. 49:173–179.
8. Al-Yatama MK, Al Essa M, Omu AE, Al-Shamali I, Egbase P, Rashwan N. Effect of repeated doses of dexamethasone on the incidence and severity of respiratory distress syndrome in multifetal gestation between 24 and 34 weeks. Gynecol Obstet Invest. 2001. 52:26–33.
9. Quist-Therson EC, Myhr TL, Ohlsson A. Antenatal steroids to prevent respiratory distress syndrome: multiple gestation as an effect modifier. Acta Obstet Gynecol Scand. 1999. 78:388–392.
10. Turrentine MA, Wilson PD, Wilkins IA. A retrospective analysis of the effect of antenatal steroid administration on the incidence of respiratory distress syndrome in preterm twin pregnancies. Am J Perinatol. 1996. 13:351–354.
11. Gibbs RS, Blanco JD, St Clair PJ, Castaneda YS. Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term. J Infect Dis. 1982. 145:1–8.
12. Gyamfi C, Mele L, Wapner RJ, Spong CY, Peaceman A, Sorokin Y, et al. The effect of plurality and obesity on betamethasone concentrations in women at risk for preterm delivery. Am J Obstet Gynecol. 2010. 203:219.e1–219.e5.
13. Hashima JN, Lai Y, Wapner RJ, Sorokin Y, Dudley DJ, Peaceman A, et al. The effect of maternal body mass index on neonatal outcome in women receiving a single course of antenatal corticosteroids. Am J Obstet Gynecol. 2010. 202:263.e1–263.e5.
14. Antenatal corticosteroids revisited: repeat courses. NIH Consens Statement. 2000. 17:1–18.
15. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006. 3:CD004454.
16. Garite TJ, Kurtzman J, Maurel K, Clark R. Obstetrix Collaborative Research Network. Impact of a 'rescue course' of antenatal corticosteroids: a multicenter randomized placebocontrolled trial. Am J Obstet Gynecol. 2009. 200:248.e1–248.e9.
17. Wapner RJ, Sorokin Y, Thom EA, Johnson F, Dudley DJ, Spong CY, et al. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol. 2006. 195:633–642.
18. Crowther CA, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease. Cochrane Database Syst Rev. 2007. (3):CD003935.
TOOLS
Similar articles