Patricia Guselle

Effect of antenatal corticosteroids on fetal growth and gestational age at birth

OBJECTIVE: To estimate the effect of multiple courses of antenatal corticosteroids on neonatal size, controlling for gestational age at birth and other confounders, and to determine whether there was a dose–response relationship between number of courses of antenatal corticosteroids and neonatal size. METHODS: This is a secondary analysis of the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study, a double-blind randomized controlled trial of single compared with multiple courses of antenatal corticosteroids in women at risk for preterm birth and in which fetuses administered multiple courses of antenatal corticosteroids weighed less, were shorter, and had smaller head circumferences at birth. All women (n=1,858) and children (n=2,304) enrolled in the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study were included in the current analysis. Multiple linear regression analyses were undertaken. RESULTS: Compared with placebo, neonates in the antenatal corticosteroids group were born earlier (estimated difference and confidence interval [CI]: −0.428 weeks, CI −0.10264 to −0.75336; P=.01). Controlling for gestational age at birth and confounding factors, multiple courses of antenatal corticosteroids were associated with a decrease in birth weight (−33.50 g, CI −66.27120 to −0.72880; P=.045), length (−0.339 cm, CI −0.6212 to −0.05676]; P=.019), and head circumference (−0.296 cm, −0.45672 to −0.13528; P<.001). For each additional course of antenatal corticosteroids, there was a trend toward an incremental decrease in birth weight, length, and head circumference. CONCLUSION: Fetuses exposed to multiple courses of antenatal corticosteroids were smaller at birth. The reduction in size was partially attributed to being born at an earlier gestational age but also was attributed to decreased fetal growth. Finally, a dose–response relationship exists between the number of corticosteroid courses and a decrease in fetal growth. The long-term effect of these findings is unknown. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00187382. LEVEL OF EVIDENCE: II

The costs of planned cesarean versus planned vaginal birth in the Term Breech Trial

Background: The Term Breech Trial compared the safety of planned cesarean and planned vaginal birth for breech presentations at term. The combined outcome of perinatal or neonatal death and serious neonatal morbidity was found to be significantly lower among babies delivered by planned cesarean section. In this study we conducted a cost analysis of the 2 approaches to breech presentations at delivery. Methods: We used a third-party–payer (i.e., Ministry of Health) perspective. We included all costs for physician services and all hospital-related costs incurred by both the mother and the infant. We collected health care utilization and outcomes for all study participants during the trial. We used only the utilization data from countries with low national rates of perinatal death (≤ 20/1000). Seven hospitals across Canada (4 teaching and 3 community centres) were selected for unit cost calculations. Results: The estimated mean cost of a planned cesarean was significantly lower than that of a planned vaginal birth (

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial

7165 v.

Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial.

8042 per mother and infant; mean difference –

Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study Outcomes in Children at 5 Years of Age (MACS-5)

877, 95% credible interval –

Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for preterm birth study at 5 years of age (MACS-5)

1286 to –

Multiple Courses of Antenatal Corticosteroids for Preterm Birth (MACS) : A Randomized Controlled Trial

473). The estimated mean cost of a planned cesarean was lower than that of a planned vaginal birth for both women having a first birth (

656: Multiple courses of antenatal corticosteroids for preterm birth study at 5 years of age (MACS-5): association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years of age

7255 v.

456: Multiple courses of antenatal corticosteroids for preterm birth study (MACS): results of the three month maternal post partum questionnaire

8440) and women having had at least one prior birth (

Effect of Antenatal Corticosteroids on Fetal Growth and Gestational Age at Birth

7071 v.