Antenatal Corticosteroids in Diabetic Pregnancies and Outcomes of Very Preterm Infants: a National Multicenter Cohort Study

Background Antenatal corticosteroids (ACS) can improve the outcomes of preterm infants and have been widely adopted as the standard practice in managing pregnancies at high risk of preterm delivery between 24 ^+ 0 and 33 ^+ 6 weeks. Due to their significant benefit for the majority of pregnant women, an European guideline also state that maternal diabetes is not a contraindication for the use of ACS. However, no such evidence has been obtained from diabetic pregnancies. Methods The Chinese Neonatal Network (CHNN), a national multicenter study, recruited 31,915 very preterm infants (VPIs) from 79 NICUs. A total of 4337 VPIs born to diabetic mothers enrolled in the present study: 3605 VPIs were exposed to ACS and 732 were not. The outcomes were mortality and severe morbidity in hospital. Logistic regression models were employed to calculate the odds ratio (OR) and its 95% confidence interval (CI) to estimate the associations between ACS and these outcomes. Stratification and sensitivity analyses were conducted to test the robustness of the results in different population. Findings: ACS was associated with a lower risk in the combined outcome (death or any severe morbidity) (adjusted OR [aOR] 0.66, 95%CI: 0.54–0.79), death (aOR 0.55, 95%CI 0.41–0.73), and bronchopulmonary dysplasia (aOR 0.69, 95%CI 0.55–0.85). However, a significantly higher risk of maternal chorioamnionitis (aOR 2.09, 95%CI 1.61–2.72) was observed in the ACS group. Similar results were observed in stratification and sensitivity analyses. Conclusions ACS is associated with lower mortality and reduced morbidity in VPIs born to diabetic mothers.