Impact Of Antenatal Corticosteroids On Neonatal Hypoglycemia And Hyperbilirubinemia In Preterms - A Prospective Cohort Study
Keywords:
maternal, antenatal corticosteroids, Hypoglycemia, hyperbilirubinemia, preterm, neonateAbstract
Background: Antenatal corticosteroids (ACS) are routinely administered to pregnant women at risk of preterm delivery to promote fetal lung maturation and reduce neonatal morbidity and mortality. However, emerging evidence suggests that ACS may influence neonatal outcomes such as hypoglycemia and hyperbilirubinemia, with inconsistent findings across studies.
Objectives: To evaluate the association of antenatal corticosteroid exposure with neonatal hypoglycemia and hyperbilirubinemia in preterm neonates.
Methods: This prospective cohort study was conducted over 1.5 years at R.L. Jalappa Hospital. A total of 120 preterm neonates (<37 weeks gestation) were enrolled—60 with maternal ACS exposure and 60 without. Neonates with maternal diabetes, sepsis, hypoxic ischemic encephalopathy, or Rh incompatibility were excluded. Blood glucose was monitored every 6 hours for 72 hours post-birth. Hyperbilirubinemia was assessed via transcutaneous or serum bilirubin every 12 hours. Data were analysed using SPSS v21.0, with p < 0.05 considered statistically significant.
Results: Hypoglycemia was significantly more common in the ACS group (55%) compared to the non-ACS group (5%) (p < 0.001), with an odds ratio of 23.22 (95% CI: 6.53–82.48). In contrast, the rate of hyperbilirubinemia was comparable between groups (41.7% in ACS vs. 53.3% in non-ACS, p = 0.20).
Conclusion: Antenatal corticosteroid exposure in preterm neonates is significantly associated with an increased risk of neonatal hypoglycemia but not hyperbilirubinemia. These findings highlight the importance of vigilant glucose monitoring in ACS-exposed preterm infants, particularly during the first 72 hours of life.
Downloads
Metrics
References
Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 2019;7(1):e37–46.
Gyamfi-Bannerman C, Thom EA, Blackwell SC, Tita ATN, Reddy UM, Saade GR, et al. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. New England Journal of Medicine 2016;374(14):1311–20.
McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2020;2021(2).
Pettit KE, Tran SH, Lee E, Caughey AB. The association of antenatal corticosteroids with neonatal hypoglycemia and hyperbilirubinemia. The Journal of Maternal-Fetal & Neonatal Medicine 2014;27(7):683–6.
Olefsky J, Nolan J. Insulin resistance and non-insulin-dependent diabetes mellitus: cellular and molecular mechanisms. Am J Clin Nutr 1995;61(4):980S-986S.
Németh I, Szeleczki T, Boda D. Hyperbilirubinemia and urinary D-glucaric acid excretion in premature infants following antepartum dexamethasone treatment. J Perinat Med 1981;9(1):35–9.
Moisiadis VG, Matthews SG. Glucocorticoids and fetal programming part 1: outcomes. Nat Rev Endocrinol 2014 Jul 27;10(7):391–402.
Moisiadis VG, Matthews SG. Glucocorticoids and fetal programming part 2: mechanisms. Nat Rev Endocrinol 2014;10(7):403–11.
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. The Lancet 2008;371(9606):75–84.
Hamer J, Jabeen M, Gurney L, Morris RK, Morton VH. A practical guide to understanding fetal growth and newborn birthweight charts. Obstet Gynaecol Reprod Med 2024;34(9):244–51.
Adamkin DH. Neonatal hypoglycemia. Semin Fetal Neonatal Med 2017 ;22(1):36–41.
Amos RC, Jacob H, Leith W. Jaundice in newborn babies under 28 days: NICE guideline 2016 (CG98). Arch Dis Child Educ Pract Ed 2017;102(4):207–9.
Üstün N, Hocaoğlu M, Turgut A, Arslanoğlu S, Ovalı F. Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth? The Journal of Maternal-Fetal & Neonatal Medicine 2022 ;35(1):11–7.
Gyamfi-Bannerman C, Jablonski KA, Blackwell SC, Tita ATN, Reddy UM, Jain L, et al. Evaluation of Hypoglycemia in Neonates of Women at Risk for Late Preterm Delivery: An Antenatal Late Preterm Steroids Trial Cohort Study. Am J Perinatol 2023;40(05):532–8.
Zhou C, Zheng W, Zhang M, Tung TH, Wang L, Wang L. Effects of antenatal corticosteroids on neonatal blood glucose fluctuation in late-preterm infants. Front Pediatr 2022;10.
di Pasquo E, Saccone G, Angeli L, Dall’Asta A, Borghi E, Fieni S, et al. Determinants of neonatal hypoglycemia after antenatal administration of corticosteroids (ACS) for lung maturation: Data from two referral centers and review of the literature. Early Hum Dev 2020;143:104984.
El-Garhy MA GA. Antenatal Corticosteroid Exposure As a Risk Factor For Neonatal Hyperbilirubinemia. Fayoum University Medical Journal 2021;8(4):12–9.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
