Neonatal hypoglycaemia in early preterm infants exposed to antenatal steroid therapy in pregnant mothers with diabetes: a retrospective cohort study

Abstract

Objective To compare the incidence of neonatal hypoglycaemia (NH) in early preterm infants born to mothers with diabetes who were exposed to antenatal corticosteroids (ACS) and those born to mothers without diabetes who were also exposed to ACS. Study

Methods A retrospective cohort study of pregnant mothers who delivered between 28 0/7 and 33 6/7 weeks of gestation who had received ACS. All deliveries were at Columbia University Medical Centre, a tertiary care centre in the city of New York. ACS doses and timing of administration prior to delivery were compared between primary exposure groups, mothers diagnosed with diabetes versus mothers without diabetes. The primary outcome was $\mathrm{N}\mathrm{H}(<40\mathrm{m}\mathrm{g}/\mathrm{d}\mathrm{L})$ within the first 48 hours of life. Associations were tested using ${\chi }^{2}$ test and logistic regression.

Results Of 212 eligible patients, neonates of mothers with diabetes demonstrated a higher rate of NH (39.4% vs 19.6%,p=0.01 ). Other risk factors of NH included maternal body mass index and maternal age at delivery. Steroid dose and timing of administration were not determinant factors in developing NH.

Conclusions Early preterm neonates of mothers with diabetes who received ACS have a higher risk of NH. However, due to the lack of a control group of unexposed infants, the direct impact of ACS on NH cannot be conclusively determined.

Contributors SA-N designed the study and wrote the project proposal, was responsible for all IRB submissions, collected and analysed data, drafted, edited and revised the paper. RM analysed, edited and revised the paper. E0 analysed, edited and revised the paper. QY wrote the statistical analysis plan and analysed the data. CG-B designed and supervised the study, analysed, drafted, edited and revised the paper. SA-N is the guarantor and corresponding author for this manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Disclaimer The views expressed in the submitted article are the author's own and not an official position of the institution or funder.

Competing interests The authors report no conflict of interest.

Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

Patient consent for publication Not applicable.

Ethics approval All study procedures and protocols were approved by the Institutional Review Board (IRB) at Columbia University Medical Center (IRB number: IRB-AAAS7551) on 3 June 2020. Data collection was confidential, with access only available to IRB-approved research personnel. All study procedures were approved by the IRB at our tertiary care centre (IRB-AAAS7551). Informed consent was waived for this retrospective study involving deidentified, coded medical data. The study met all waiver criteria under 45 CFR 46.116, and patient confidentiality was maintained throughout.

Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement The data supporting this study are not publicly available due to confidentiality agreements but may be available from the corresponding author upon reasonable request and with permission from the Department of Obstetrics and Gynecology at Columbia University.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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ORCID iD

Sarah Al-Nafisee https://orcid.org/0009-0008-4305-7433

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