OBJECTIVE To estimate the effect of late preterm antenatal steroids on the risk of respiratory morbidity among subgroups of patients on the basis of the planned mode of delivery and gestational age at presentation. METHODS This was a secondary analysis of the ALPS (Antenatal Late Preterm Steroid) Trial, a multicenter trial conducted within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network of individuals with singleton gestations and without preexisting diabetes who were at high risk for late preterm delivery (34-36 weeks of gestation). We fit binomial regression models to estimate the risk of respiratory morbidity, with and without steroid administration, by gestational age and planned mode of delivery at the time of presentation. We assumed a homogeneous effect of steroids on the log-odds scale, as was reported in the ALPS trial. The primary outcome was neonatal respiratory morbidity, as defined in the ALPS Trial. RESULTS The analysis included 2,825 patients at risk for late preterm birth. The risk of respiratory morbidity varied significantly by planned mode of delivery (adjusted risk ratio [RR] 1.90, 95% CI, 1.55-2.33 for cesarean delivery vs vaginal delivery) and week of gestation at presentation (adjusted RR 0.56, 95% CI, 0.50-0.63). For those planning cesarean delivery and presenting in the 34th week of gestation, the risk of neonatal respiratory morbidity was 39.4% (95% CI, 30.8-47.9%) without steroids and 32.0% (95% CI, 24.6-39.4%) with steroids. In contrast, for patients presenting in the 36th week and planning vaginal delivery, the risk of neonatal respiratory morbidity was 6.9% (95% CI, 5.2-8.6%) without steroids and 5.6% (95% CI, 4.2-7.0%) with steroids. CONCLUSION The absolute risk difference of neonatal respiratory morbidity between those exposed and those unexposed to late preterm antenatal steroids varies considerably by gestational age at presentation and planned mode of delivery. Because only communicating the relative risk reduction of antenatal steroids for respiratory morbidity may lead to an inaccurate perception of benefit, more patient-specific estimates of risk expected with and without treatment may inform shared decision making.

中文翻译：

---

按计划分娩方式和胎龄划分的晚期早产患者倍他米松暴露和新生儿呼吸系统发病率。


目的 根据计划分娩方式和就诊胎龄，评估晚期早产前类固醇对患者亚组呼吸系统疾病风险的影响。方法 这是对 ALPS（产前晚期早产儿类固醇）试验的二次分析，这是一项在 Eunice Kennedy Shriver 国家儿童健康与人类发展研究所母胎医学单位网络内进行的多中心试验，该试验针对单胎妊娠且既往无糖尿病的个体，他们是晚期早产的高风险（妊娠 34-36 周）。我们拟合二项式回归模型，以根据胎龄和就诊时的计划分娩方式来估计有和没有类固醇给药的呼吸系统发病率风险。我们假设类固醇对对数比值量表的影响是均匀的，如 ALPS 试验中报道的那样。主要结局是新生儿呼吸系统发病率，如 ALPS 试验所定义。结果 该分析包括 2,825 例有晚期早产风险的患者。呼吸系统并发症的风险因计划分娩方式 （校正风险比 [RR] 1.90,95% CI，剖宫产与阴道分娩 1.55-2.33）和就诊时妊娠周数 （校正 RR 0.56,95% CI，0.50-0.63） 而异。对于计划剖宫产并在妊娠第 34 周就诊的患者，未使用类固醇的新生儿呼吸系统疾病风险为 39.4% （95% CI，30.8-47.9%），使用类固醇的新生儿呼吸系统疾病风险为 32.0% （95% CI，24.6-39.4%）。相比之下，对于第 36 周就诊并计划阴道分娩的患者，不使用类固醇的新生儿呼吸系统疾病风险为 6.9% （95% CI，5.2-8.6%），使用类固醇的新生儿呼吸系统发病率风险为 5.6% （95% CI，4.2-7.0%）。 结论 暴露于晚期早产儿类固醇的患者和未暴露于晚期早产儿类固醇的患者之间新生儿呼吸系统发病率的绝对风险差异因就诊时的胎龄和计划的分娩方式而异。因为只传达产前类固醇对呼吸系统疾病的相对风险降低可能会导致对益处的不准确认识，所以对有和没有治疗的预期风险的更多患者特异性估计可能会为共同决策提供信息。