Neonatal hypoglycemia following antenatal corticosteroid treatment prior to elective cesarean delivery during the early term period: a meta-analysis

Vasilios Pergialiotis; Kalliopi Rodolaki; Melina Nikolakea; Panagiotis Antsaklis; Sofoklis Stavros; Periklis Panagopoulos; Nikolaos Vrachnis; Georgios Daskalakis

doi:10.1016/j.xagr.2023.100179

Neonatal hypoglycemia following antenatal corticosteroid treatment prior to elective cesarean delivery during the early term period: a meta-analysis

AJOG Glob Rep. 2023 Feb 15;3(2):100179. doi: 10.1016/j.xagr.2023.100179. eCollection 2023 May.

Authors

Vasilios Pergialiotis^{1

2}, Kalliopi Rodolaki^{2

3}, Melina Nikolakea², Panagiotis Antsaklis¹, Sofoklis Stavros⁴, Periklis Panagopoulos⁴, Nikolaos Vrachnis⁴, Georgios Daskalakis¹

Affiliations

¹ 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece (Drs Pergialiotis, Antsaklis, and Daskalakis).
² Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece (Drs Pergialiotis, Rodolaki, and Nikolakea).
³ 1st Department of Pediatrics, "Aghia Sophia" Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dr Rodolaki).
⁴ 3rd Department of Obstetrics and Gynecology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece (Drs Stavros, Panagopoulos, and Vrachnis).

Abstract

Objective: The necessity of administering antenatal corticosteroids in early-term neonates delivered by planned cesarean delivery remains arbitrary as their observed benefit addresses a few cases that may need pulmonary resuscitation. However, to date, whether the use of antenatal corticosteroids in the preterm period is associated with neonatal hypoglycemia, which is the most prominent neonatal side effect during this period, remains unknown. This study aimed to determine the effect of antenatal corticosteroids administered during the early term period on neonatal hypoglycemia rates.

Data sources: The databases of Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar were used.

Study eligibility criteria: Published clinical trials and observational studies were considered eligible.

Methods: A modified data form that was based on the Cochrane data collection form for intervention reviews for randomized controlled trials and nonrandomized controlled trials was used. Meta-analysis was performed using RStudio (RStudio, Inc, Boston, MA). The quality of included studies was assessed with the Risk Of Bias In Non-randomized Studies of Interventions tool. Trial sequential analysis was performed to evaluate the sample size.

Results: A total of 6 studies of moderate risk of bias were included in this systematic review consisting of 1273 parturients, of whom 537 received corticosteroids. The risk of neonatal hypoglycemia did not increase with the use of antenatal corticosteroids before early-term elective cesarean delivery (odds ratio, 1.80; 95% confidence interval, 0.45-7.25). Similarly, the risk of admission to the neonatal intensive care unit for respiratory distress syndrome or transient tachypnoea of the newborn was not affected by the use of corticosteroids (odds ratio, 0.61; 95% confidence interval, 0.19-1.99).

Conclusion: The use of antenatal corticosteroids did not seem to increase the risk of neonatal hypoglycemia. Given the quality and sample size of included studies, the effect size cannot be accounted for as definitive and cannot be directly applied in clinical practice. However, the provided information can be used as a guide for women participating in future trials.

Keywords: antenatal corticosteroids; meta-analysis; neonatal hypoglycemia; respiratory distress syndrome; transient tachypnea.

Publication types

Review