STUDY: Prenatal Steroids Lower Risk Of Respiratory Illness In Late Preterm Infants

baby with doctorsPrenatal steroid therapy reduces the chance of respiratory complications among infants born at 34-36 weeks, so-called “late” preterm infants, according to a study by a National Institutes of Health research network.

Steroids are a standard treatment for women likely to deliver before 34 weeks of pregnancy because these drugs are known to reduce respiratory and other complications, as well as death, among infants born early preterm. Now, researchers have found that steroids also reduce the occurrence of serious respiratory complications in late preterm infants.

Previously, it was believed that late preterm infants could thrive without their mothers having received steroid treatment. Researchers then learned that late preterm infants have a higher risk of respiratory complications compared to infants born at 37 weeks or later.

“Eight percent of all deliveries occur in the late preterm period,” said study author Uma Reddy, M.D., M.P.H., of the Pregnancy and Perinatology Research Branch at the NIH’s Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD). “Our results indicate that prenatal steroid therapy for women delivering late preterm could greatly reduce the rate of serious respiratory complications in this group of infants.”

The study was co-funded by NICHD and the National Heart, Lung and Blood Institute (NHLBI).

“Reducing neonatal respiratory complications could result in less injury to the immature lung, less hospitalizations, earlier infant-mom bonding, and better long-term lung and general health,” said Carol Blaisdell, MD, NHLBI medical officer and program officer for the study.

Women who participated in the study were in the 34th through the 36th week of their pregnancies, and at high risk for delivering early (before 37 weeks).The researchers randomly assigned 2,831 participants to receive two injections of the steroid betamethasone or a placebo, 24 hours apart.

The researchers categorized the study findings into a single composite measure, a primary outcome derived from the need for any of a number of therapies used to treat difficulty in breathing in the newborns, including:

  • Continuous positive airway pressure (CPAP), use of mild air pressure, so that sufficient air can reach the lungs.
  • Oxygen therapy, in which oxygen at concentrations higher than that in room air is passed into the baby’s lungs.
  • Mechanical ventilation, in which a tube is placed in the infant’s windpipe and used to deliver oxygen to the infant’s lungs.

Also included in the primary outcome was whether an infant was stillborn or died before 72 hours of age.

At the study’s conclusion, 11.6 percent of the infants in the betamethasone group met the criteria for the primary outcome—a 20 percent reduction in the need for respiratory support by 72 hours of age, compared to the placebo group. Two infants in the betamethasone group died before 72 hours, but these deaths were not from respiratory causes. One infant died from a heart defect, and the other from sepsis, a blood infection that frequently occurs in preterm infants. The rate of sepsis (a serious blood infection) was roughly the same for both groups.

The researchers also evaluated the infants according to several secondary outcomes. The first of these, severe respiratory illness, included the need for CPAP therapy or supplemental oxygen for at least 12 continuous hours, a high concentration of oxygen for at least 24 hours, or mechanical ventilation. Again, the betamethasone group fared better, with 8.1 percent qualifying for this secondary outcome—a 33 percent reduction in serious respiratory illness compared to the placebo group. Infants in the betamethasone group also were less likely to experience transient tachypnea (fluid in the lungs) or bronchopulmonary dysplasia—tissue damage and scarring that may accompany oxygen or ventilator therapy.

Infants in the betamethasone group were more likely to have low blood sugar than those in the placebo group (24 percent vs. 14.9 percent). Therefore, the data support the monitoring of neonatal blood sugar levels when steroids are given in this situation.  Overall, betamethasone administration for women at risk for late preterm delivery decreased the rate of respiratory complications in their infants. Although the drug increased the risk of low blood sugar in the infants, there were no other differences in complication rates between infants or their mothers.

5 Things Black Women Should Know About Preterm Birth

man resting his head on his wife's pregnant stomachHaving a ‘bun in the oven’ can be a time of excitement and joy of what’s to come, but if your bun doesn’t ‘bake’ long enough that can be cause for serious concern. According to the CDC, preterm (or premature) labor is responsible for more than one-third of infant deaths during their first year of life. Black infants are particularly susceptible and 2.4 times more likely to be affected versus white infants.

Most babies born prior to 24 weeks have little chance of survival.

Only about 50% will survive and the other 50% may die or have permanent problems. However, babies born after 32 weeks have a very high survival rate and usually do not have long term complications. Premature babies born at hospitals with neonatal intensive care units (NICU) have the best results.

The longer your baby is in the womb, the better the chance he or she will be healthy. Here are five things every expectant mother should know about preterm birth to alleviate fears, minimize potential complications and have a healthy pregnancy.

1. What is preterm labor? 

A normal pregnancy lasts about 40 weeks, according to the American Pregnancy Association. Preterm labor is when a baby is born before 37 weeks of pregnancy gestation. When a baby is born before this period, they are at increased risk for suffering many complications. These include disabilities developing around their neurological system, children having cerebral palsy or other learning disabilities. Preterm infants stay in the hospital longer and may experience more readmissions to the hospital for additional medical care.

2. African-American women have a higher risk of preterm labor.

African-American women have a higher risk for preterm labor and birth complications. Approximately 1 in 6 Black babies are born prematurely in the U.S. According to a CDC fact sheet, “the risk of preterm birth for Non-Hispanic black women is approximately 1.5 times the rate seen in white women.”  In an article for The Huffington PostLisa Gittens-Williams, M.D. Associate Professor, Obstetrics, Gynecology and Women’s Health, UMDNJ-New Jersey Medical School, wrote, “The reasons for these differences are still under investigation, and actions to reduce the preterm birth rate in this population are underway.”

3. What causes preterm labor?

There are several risk factors for preterm births and many are controllable with simple lifestyle changes. While all expectant mothers (or women looking to become pregnant) should know about the risk factors, knowing becomes especially important for women who:

  • Had a previous preterm delivery
  • Smoke cigarettes
  • Drink alcohol
  • Use illicit drugs (e.g., cocaine)
  • Have little or no prenatal care
  • Have high stress levels
  • Have a chronic like high blood pressure, kidney disease or diabetes
  • Are underweight or overweight before pregnancy
  • Are pregnant with multiples

4. What are the warning signs of preterm labor?

There are symptoms that may signal you’re in preterm labor. To prevent a premature birth, the American Pregnancy Association suggests you call and/or see your doctor immediately if you experience:

  • Five or more uterine contractions in an hour
  • Watery fluid leaking from your vagina (this could indicate that your water has broken)
  • Menstrual-like cramps in the lower abdomen that can come and go or be constant
  • Low, dull backache felt below the waistline that may come and go or be constant
  • Pelvic pressure that feels like your baby is pushing down
  • Abdominal cramps that may occur with or without diarrhea
  • Increase or change in vaginal discharge

It’s important to know that preterm labor does not always result in premature delivery. Some women with premature labor and early dilation of the cervix are put on bed rest until the pregnancy progresses.

5. How can preterm labor be prevented? 

Women can have a healthier pregnancy by making sure they receive prenatal care as soon as they become aware they are pregnant.

Additionally, make sure you are doing the following:

  • Take multivitamins and folic acid every day during your pregnancy.
  • Be aware of your lifestyle habits and eating healthier will help to decrease preterm labor from happening to you as well.
  • Avoid smoking, alcohol and drugs to help you to have a healthier fetus.
  • See your doctor regularly. Inform your doctor if you have medical issues or family history which could impact your pregnancy.
  • If you are working in an environment that exposes you to harmful substances, change your work environment. Work in an area where you do not have exposure to these chemicals.
  • Make sure the meat you eat is cooked well and not under-processed.