Objective: To systematically evaluate the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates. Methods: Eight databases in either Chinese or English, including PubMed, the Cochrane Library, Embase, Medline, Scopus, CNKI, Wanfang and VIP, were searched to extract the studies on the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates published from the establishment of each database to December 2022. The Meta-analysis was performed using Stata 14.0 statistical software. Results: A total of 9 studies were included in this Meta-analysis, including 6 retrospective cohort studies, 2 prospective cohort studies and 1 randomized controlled trial (RCT) study, involving 9 143 premature infants. The Meta-analysis showed that prenatal steroid exposure increased the risk of late preterm neonatal hypoglycemia (RR=1.55, 95%CI 1.25-1.91, P<0.001). The similar correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates was all found in the following subgroups: North America (RR=1.57, 95%CI 1.37-1.80, P<0.001), enrolling pregnant women with gestational diabetes (RR=1.62, 95%CI 1.26-2.08, P<0.001), A-grade literature quality (RR=1.43, 95%CI 1.14-1.79, P=0.002), criteria for hypoglycemia ≤40 mg/dl (1 mg/dl=0.056 mmol/L, RR=1.49, 95%CI 1.28-1.73, P<0.001), sample size of 501-1 500 (RR=1.69, 95%CI 1.19-2.40, P=0.003) and >1 500 (RR=1.65, 95%CI 1.48-1.83, P<0.001), steroid injection dosage and frequency of 12 mg 2 times (RR=1.66, 95%CI 1.50-1.84, P<0.001), the time interval from antenatal corticosteroid administration to delivery of 24-47 h (RR=1.98, 95%CI 1.26-3.10, P=0.003), unadjusted gestational age (RR=1.78, 95%CI 1.02-3.10,P=0.043) and unadjusted birth weight (RR=1.80, 95%CI 1.22-2.66, P=0.003). Meta-regression results showed that steroid injection frequency and dose were the main sources of high heterogeneity among studies (P=0.030). Conclusion: Prenatal steroid exposure may be a risk factor for hypoglycemia in late preterm neonates.
目的： 系统评价母产前类固醇暴露与晚期早产新生儿低血糖的相关性。 方法： 计算机检索PubMed、the Cochrane Library、Embase、Medline、Scopus、中国知网、万方和维普8个中英文数据库，搜集关于母产前类固醇暴露与晚期早产新生儿低血糖相关性的研究，检索时限均为建库至2022年12月。采用Stata 14.0统计软件进行Meta分析。 结果： 共纳入9项研究，其中回顾性队列研究6项、前瞻性队列研究2项、随机对照试验（RCT）研究1项，涉及早产儿9 143例。Meta分析结果显示，母产前类固醇暴露可增加晚期早产新生儿低血糖的发生风险（RR=1.55，95%CI 1.25~1.91，P<0.001）。亚组分析显示，地域为北美洲（RR=1.57，95%CI 1.37~1.80，P<0.001）、包含患有妊娠糖尿病孕母（RR=1.62，95%CI 1.26~2.08，P<0.001）、文献质量为A级（RR=1.43，95%CI 1.14~1.79，P=0.002）、低血糖标准为≤40 mg/dl（1 mg/dl=0.056 mmol/L，RR=1.49，95%CI 1.28~1.73，P<0.001）、样本量为501~1 500 例（RR=1.69，95%CI 1.19~2.40，P=0.003）、样本量>1 500 例（RR=1.65，95%CI 1.48~1.83，P<0.001）、类固醇注射剂量及频次为12 mg 2次（RR=1.66，95%CI 1.50~1.84，P<0.001）、母产前类固醇给药至分娩时间为24~47 h（RR=1.98，95%CI 1.26~3.10，P=0.003）、未调整出生胎龄（RR=1.78，95%CI 1.02~3.10，P=0.043）和未调整出生体重（RR=1.80，95%CI 1.22~2.66，P=0.003）的研究均显示，母产前类固醇暴露可增加晚期早产新生儿低血糖的发生风险。Meta回归结果显示，类固醇的注射剂量及频次是研究间高异质性的主要来源（P=0.030）。 结论： 母产前类固醇暴露可能是晚期早产新生儿低血糖的危险因素之一。.