Association between Corticosteroid Administration in Pregnant Women with COVID-19 and Neonatal Outcomes

Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran

2 Department of Obstetrics and Gynecology, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran,

3 Department of Pediatrics, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran,

Abstract

Background: The evidence for the effect of corticosteroid administration on neonates in pregnant women who tested positive for COVID-19 is rare. This study aims to evaluate the effect of the administration of corticosteroids on pregnant women with COVID-19 on neonatal metabolic outcomes of hypoglycemia and hyperbilirubinemia.
Methods: The present retrospective cohort study was conducted on pregnant women with COVID-19 referred to Mousavi Hospital in Zanjan, Iran in 2020. We compared post-delivery complications in women who had received corticosteroids with a control group. The data were extracted from the medical records of the patients by a resident of the gynecology. The chi-square test was used to compare the rate of hyperbilirubinemia and hypoglycemia between groups.
Results: Of a total of 71 investigated patients, only 32 received non-steroidal anti-inflammatory drugs (NSAIDs),. The mean age of the patients was 29.77±6.87 years and there was not a significant difference between the two groups in terms of age, BMI, education, blood sugar, bilirubin, neonate weight, and 1 and 5-minute Apgar score (P>0.05). In the corticosteroid-receiving group, a significantly higher rate of hypoglycemia (37.5% vs. 7.69%, P=0.002) and hyperbilirubinemia (25% vs. 5.13%, P=0.02) was reported.
Conclusion: The results suggested that the administration of corticosteroids as a treatment modality for pregnant women with COVID-19 is associated with an increased rate of neonatal hypoglycemia and hyperbilirubinemia. Therefore, glycemic control is necessary for neonates born from pregnant women with COVID-19 exposed to corticosteroids during the pregnancy.
 
 

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  1. Wastnedge EA, Reynolds RM, Van Boeckel SR, Stock SJ, Denison FC, Maybin JA, et al. Pregnancy and COVID-19. Physiological Reviews. 2021;101(1):303-18.
  2. Sutton D, Fuchs K, D’alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. New England Journal of Medicine. 2020;382(22):2163-4.
  3. Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews. 2017(3).
  4. 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(12).
  5. Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews. 2013(8).
  6. D'Souza R, Ashraf R, Rowe H, Zipursky J, Clarfield L, Maxwell C, et al. Pregnancy and COVID‐19: pharmacologic considerations. Ultrasound in Obstetrics & Gynecology. 2021;57(2):195-203.
  7. Mitra AR, Gellatly R, Rowe H, Johnson SR. Corticosteroids in the Management of Pregnant Patients With Coronavirus Disease (COVID-19). Obstetrics & Gynecology. 2021;137(2):379-80.
  8. Warmflash D. COVID-19 therapeutics in pregnancy and lactation: corticosteroids. Avaialble at: https://blog.pregistry.com/covid-19-therapeutics-in-pregnancy-and-lactation-corticosteroids/?utm_source=rss&utm_medium=rss&utm_campaign=covid--therapeutics-in-pregnancy-and-lactation-corticosteroids.
  9. Pedersen J, Bojsen-Møller B, Poulsen H. Blood sugar in newborn infants of diabetic mothers. European Journal of Endocrinology. 1954;15(1):33-52.
  10. 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.
  11. Sann L, Burnod J, Lasne Y, Bethenod M. Antenatal administration of betamethasone. Effects upon neonatal blood glucose in premature infants (author's transl). La Nouvelle Presse Medicale. 1979;8(39):3147-8.
  12. Rokicki W, Krasnodębski J. Antenatal glucocorticoid administration and neonatal glycemia. Developmental Pharmacology and Therapeutics. 1987;10:307-11.
  13. Valencia GMG, Rojas VCM. Association between antenatal steroids for lung maturation and hypoglycaemia in the first 48 hours in premature infants between 26 and 34 weeks of gestational age. Pediatric Endocrinology, Diabetes, and Metabolism. 2019;25(4):177-82.
  14. Madendag IC, Sahin ME. The effects of antenatal corticosteroid exposure on the rate of hyperbilirubinemia in term newborns. Pakistan Journal of Medical Sciences. 2019;35(6):1582.
  15. Barondiot C, Morel O, Vieux R, Sery G, Floriot M, Hascoet J. Antenatal betamethasone during pregnancy with severe diabetes: is better worse than good? Archives de pediatrie: Organe Officiel de la Societe Francaise de Pediatrie. 2007;14(8):989-92.
  16. Schumacher A, Sidor J, Bühling KJ. Continuous glucose monitoring using the glucose sensor CGMS in metabolically normal pregnant women during betamethasone therapy for fetal respiratory distress syndrome. Zeitschrift fur Geburtshilfe und Neonatologie. 2006;210(5):184-90.
  17. Zigron R, Rotem R, Erlichman I, Rottenstreich M, Rosenbloom JI, Porat S, et al. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: it's all about timing. International Journal of Gynecology & Obstetrics. 2021.
  18. Aydin M, Deveci U, Hakan N. Neonatal hypoglycemia associated with the antenatal corticosteroids may be secondary to fetal adrenal suppression. The Journal of Maternal-Fetal & Neonatal Medicine. 2015;28(8):892-.
  19. 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 Human Development. 2020;143:104984.
  20. Viar JRG, Cunanan EC. The Association of Antenatal Steroids and Hypoglycemia in Preterm Neonates. Journal of Medicine, University of Santo Tomas. 2021;5(1):604-10.