The Interaction of Antenatal Steroid Timing and Pre-Eclampsia on Respiratory Outcomes Among Infants Born Preterm.

Summary

In a prospective cohort of 1172 infants at 23–30 weeks’ gestation, antenatal corticosteroids given within 7 days of birth mitigated the increased risks of severe RDS and moderate-to-severe BPD associated with pre-eclampsia. Earlier (>7 days) steroid exposure was linked to higher risks, underscoring the importance of timing.

Key Findings

• Among 1172 infants, 30% had maternal pre-eclampsia and 83% received antenatal steroids within 7 days of birth.
• Pre-eclampsia with antenatal steroids given earlier than 7 days before birth was associated with increased severe RDS risk versus the reference (no pre-eclampsia with ≤7 days ANS).
• Pre-eclampsia with antenatal steroids within 7 days was not associated with increased severe RDS risk.
• Both non–pre-eclampsia with >7 days ANS and pre-eclampsia with >7 days ANS were associated with increased moderate-to-severe BPD risk; pre-eclampsia with ≤7 days ANS was not.

Clinical Implications

Coordinate obstetric-neonatal care to administer antenatal corticosteroids within 7 days of anticipated delivery in pre-eclampsia to reduce severe RDS and BPD risk.

Limitations

• Single-center design limits generalizability
• Observational design cannot fully rule out residual confounding (e.g., illness severity, delivery indications)

Future Directions

Multi-center validation and decision-analytic studies to operationalize timing protocols for antenatal steroids in pre-eclampsia.