Abstract
Objective Antenatal corticosteroids given prior to preterm deliveries reduce the risk of adverse
neonatal outcomes. However, steroid administration in the setting of a viral respiratory
infection can worsen maternal outcomes. Therefore, the decision to administer corticosteroids
must balance the neonatal benefits with the potential harm to the mother if she is
infected with the novel coronavirus disease 2019 (COVID-19). This study aimed to determine
the gestational ages for which administering antenatal corticosteroids to women at
high risk of preterm labor with concurrent COVID-19 infection results in improved
combined maternal and infant outcomes.
Study Design A decision-analytic model using TreeAge (2020) software was constructed for a theoretical
cohort of hospitalized women with COVID-19 in the United States. All model inputs
were derived from the literature. Outcomes included maternal intensive care unit (ICU)
admission and death, along with infant outcomes of death, respiratory distress syndrome,
intraventricular hemorrhage, and neurodevelopmental delay. Quality-adjusted life years
(QALYs) were assessed from the maternal and infant perspectives. Sensitivity analyses
were performed to determine if the results were robust over a range of assumptions.
Results In our theoretical cohort of 10,000 women delivering between 24 and 33 weeks of gestation
with COVID-19, corticosteroid administration resulted in 2,200 women admitted to the
ICU and 110 maternal deaths. No antenatal corticosteroid use resulted in 1,500 ICU
admissions and 75 maternal deaths. Overall, we found that corticosteroid administration
resulted in higher combined QALYs up to 31 weeks of gestation in all hospitalized
patients, and up to 29 weeks of gestation in ICU patients.
Conclusion Administration of antenatal corticosteroids at less than 32 weeks of gestation for
hospitalized patients and less than 30 weeks of gestation for patients admitted to
the ICU resulted in higher combined maternal and infant outcomes compared with expectant
management for women at high risk of preterm birth with COVID-19 infection. These
results can guide clinicians in their counseling and management of these pregnant
women.
Key Points
-
Antenatal steroids reduce adverse neonatal outcomes.
-
Steroids worsen maternal outcomes in COVID-19.
-
Steroids given < 32 weeks result in improved outcomes.
Keywords
preterm birth - COVID-19 - antenatal steroids - respiratory infection
