Impact Of Dexamethasone On The Prognosis Of Women With Preeclampsia And Their Premature Offspring

Objective:The objective of the study was to demonstrate the therapy of prenatal dexamethasone(DXMS)for fetal lung maturation in preeclampsia(PE)and its impact on maternal and neonatal outcome.Then evaluate the safety and efficacy of antenatal corticosteroids(ACS)therapy in patients with preeclampsia,so as to optimize the ACS therapy,and to provide some recommendations for clinical management of PE patients.Methods:A retrospective study was performed among 271 patients with preeclampsia who were admitted to Qilu Hospital of Shandong University from 1/1/2018 to 8/31/2019.According to delivery pregnancy week,271 patients were divided into:Group A:early preterm birth(28+0-31+6 weeks'delivery);Group B:mid-term preterm birth(32+0-33+6 weeks' delivery);Group C:late premature birth(34+0-36+6 weeks' delivery).Then,every group was divided into two subgroups according to whether they had received dexamethasone(DXMS)before delivery:The DXSM group(Al,B1,C1):Patients were administered 1 course dose of dexamethasone(4 consecutive doses of 5 mg dexamethasone intramuscularly,12 h apart)during hospitalization,and delivered within 7 days after the first dose;No DXSM Group(A2,B2,C2):Patients were not administered with dexamethasone.Clinical characteristics between two groups were compared using nonparametric rank sum test for continuous data,and two-sided exact chi-square test for categorical data.A P-value of<0.05 was considered to be statistically significant.Univariate and multivariate logistic regression was used to analyze the high-risk factors associated with poor prognosis of parturients and offspring.Results:1.Comparison of basic characteristics.There were no statistically significant differences in age,BMI,parity,type of pregnancy-induced hypertension,blood pressure during pregnancy and test results between the DXMS groups and the No DXMS groups(P>0.05).2.Comparison of maternal complications before delivery.There was no statistically significant difference in the incidence of gestational diabetes mellitus,oligohydramnios,ascites,threatened premature delivery,premature rupture of fetal membranes before delivery between the DXMS groups and the No DXMS groups(P>0.05).3.Comparison of delivery outcome.In Group A and B,the median neonatal birth weight of the DXMS groups was lower than that of the No DXMS groups(P=0.96,0.52).The incidence of 5th min Apgar score?7 points was lower than that of the No DXMS groups in all the three groups.There were no statistically significant differences in delivery methods,blood loss,blood transfusion requirements,neonatal birth weight,Apgar score,maternal and neonatal intensive care unit admission rates,length of hospitalization,and costs between the DXMS groups and the No DXMS groups within the three groups(P>0.05).4.Maternal adverse pregnancy outcomes.There was no statistically significant difference in the incidence of HELLP syndrome,eclampsia,heart failure,placental abruption,and postpartum hemorrhage between the DXMS groups and the No DXMS groups.5.Adverse outcomes and complications of the offspring.Although the difference was not statistically significant,the incidence of intrauterine fetal death,RDS,BPD,neonatal asphyxia and SGA in the DXMS groups were lower than those in the No DXMS groups.In the mid-term preterm birth cases,the incidence of hypoglycemia and sepsis in the DXMS group was increasing.There was no statistically significant difference in the adverse outcomes and complications of the offspring between the two groups(P>0.05).6.Analysis of risk factors for maternal adverse pregnancy outcomes.PLT(P=0.001)and AST(P=0.039)are independent risk factors for maternal adverse pregnancy outcomes.7.Analysis of risk factors for adverse outcomes and complications of the offspring.Neonatal birth weight(P<0.001)is the independent risk factor for adverse outcomes and complications of the offspring.Conclusions:1.Antenatal dexamethasone treatment has no significant influence for maternal outcomes of preeclampsia patients.2.Antenatal dexamethasone can reduce the incidence of adverse outcomes and complications in preeclampsia infants,such as low Apgar score,RDS,BPD and neonatal asphyxia.But the termination time of pregnancy should not be delayed in order to complete the antenatal corticosteroids therapy.The safety and efficacy of ACS therapy in preterm preeclampsia remains to be further evaluated by carrying out more researches.3.PLT,AST,and neonatal birth weight are independent risk factors for poor prognosis of parturients and offspring.During pregnancy,intensive monitoring,active intervention,and detecting intrauterine growth restriction as early as possible are suggested,so as to reduce the incidence of poor prognosis of PE patients and their premature offspring.