Download PDF
Am J Perinatol 2021; 38(10): 993-998
DOI: 10.1055/s-0041-1728820
SMFM Fellowship Series Article

Is Exposure to Intrapartum Prostaglandins for Labor Induction Associated with a Lower Incidence of Neonatal Respiratory Distress Syndrome?

Shannon L. Son 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
,
Amanda A. Allshouse
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Gretchen A. Heinrichs
3   Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado
,
Thomas J. Garite
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
,
Robert M. Silver
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
,
Ronald J. Wapner
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York City, New York
,
William A. Grobman
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Judith H. Chung
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California Irvine, Orange, California
,
Brian M. Mercer
7   Department of Obstetrics & Gynecology, The MetroHealth System, Case Western Reserve University, Clevelend, Ohio
,
Torri D. Metz
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, Utah
› Author Affiliations Funding This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10 HD063036, RTI International; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10 HD063041, University of Pittsburgh; U10 HD063020, Northwestern University; U10 HD063046, University of California Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah. In addition, support was provided by respective Clinical and Translational Science Institutes to Indiana University (UL1TR001108), University of California Irvine (UL1TR000153), and University of Utah (8UL1TR000105 (formerly UL1RR025764) NCATS/NIH) at the University of Utah.
› Further Information
    Permissions and Reprints

Abstract

Objective Respiratory distress syndrome (RDS) is implicated in 30% of neonatal deaths. Since prostaglandins promote surfactant secretion and labor is associated with a lower risk of RDS in term neonates, it is plausible that synthetic prostaglandin (sPG) exposure is associated with a lower risk of RDS. Thus, we evaluated the association between sPG exposure and RDS in neonates born after the induction of labor (IOL).

Study Design Secondary analysis of women with singleton pregnancies undergoing IOL at 340/7 to 420/7 weeks in the nuMoM2b study, a multicenter prospective cohort of nulliparous women. RDS rates and secondary neonatal outcomes in neonates with intrapartum sPG exposure were compared with those who had IOL with non-sPG methods (e.g., balloon catheter, amniotomy, oxytocin, and laminaria). Logistic regression models estimated the association of sPG with RDS and with secondary outcomes after adjustment for clinical and demographic factors (including gestational age). A sensitivity analysis was performed in which analysis was restricted to those with an admission cervical dilation ≤2 cm.

Results Of 10,038 women in the total cohort, 3,071 met inclusion criteria; 1,444 were exposed and 1,627 were unexposed to sPGs. Antenatal corticosteroid exposure rates were low (3.0%) and similar between groups. In univariable analysis, neonates with sPG exposure had higher rates of RDS (3.2 vs. 2.0%, odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.01–2.50). This relationship was similar by gestational age at delivery (term vs. preterm, interaction p = 0.14). After adjustment, the association between sPG and RDS was no longer significant (adjusted odds ratio: 1.4, 95% CI: 0.9–2.3). When analysis was restricted to subjects with admission cervical dilation of ≤2 cm, there was also no association between sPG exposure and RDS.

Conclusion In pregnancies between 34 and 42 weeks of gestation, exposure to sPG for cervical ripening or labor induction was not associated with newborn RDS.

Key Points

  • RDS is implicated in 30% of neonatal deaths.

  • sPG exposure was not associated with RDS.

  • Avoiding preterm birth remains crucial in RDS prevention.

Keywords

respiratory distress syndrome - neonatal respiratory distress syndrome - prostaglandin - neonatal morbidity - neonatal mortality - induction of labor

Note

These data were presented in poster form at the Society for Maternal-Fetal Medicine 40th Annual Pregnancy meeting in Grapevine, Texas, on February 6, 2020.




Publication History

Received: 18 December 2020

Accepted: 02 March 2021

Article published online:
02 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Whitsett J, Rice W, Warner B, Wert S, Pryhuber G. Acute respiratory disorders. In: Avery's Neonatology: Pathophysiology and Management of the Newborn. 6th ed.. Lippincott: Williams & Wilkins; 2005: 553-577
    Google Scholar
  • 2 Helve O, Pitkänen OM, Andersson S, O'Brodovich H, Kirjavainen T, Otulakowski G. Low expression of human epithelial sodium channel in airway epithelium of preterm infants with respiratory distress. Pediatrics 2004; 113 (05) 1267-1272
    CrossrefPubMedGoogle Scholar
  • 3 Bland R, Carlton D, Jain L. Lung fluid balance during development in neonatal lung disease. In: The Newborn Lung: Neonatology Questions and Controversies. 1st ed.. Saunders; 2008: 141-165
    Google Scholar
  • 4 Harrison V. The Newborn Baby. 5th ed.. Juta & Company Ltd; 2008
    Google Scholar
  • 5 Respiratory Morbidity in Late Preterm Births. JAMA 2010; 304 (04) 419-425
    CrossrefPubMed
  • 6 Li Y, Zhang C, Zhang D. Cesarean section and the risk of neonatal respiratory distress syndrome: a meta-analysis. Arch Gynecol Obstet 2019; 300 (03) 503-517
    CrossrefPubMedGoogle Scholar
  • 7 Indraccolo U, Pace M, Corona G, Bonito M, Indraccolo SR, Di Iorio R. Cesarean section in the absence of labor and risk of respiratory complications in newborns: a case-control study. J Matern Fetal Neonatal Med 2019; 32 (07) 1160-1166
    CrossrefPubMedGoogle Scholar
  • 8 Singh M, Patole S, Rane A, Naidoo D, Buettner P. Maternal intravaginal prostaglandin E2 gel before elective caesarean section at term to induce catecholamine surge in cord blood: randomised, placebo controlled study. Arch Dis Child Fetal Neonatal Ed 2004; 89 (02) F131-F135
    CrossrefPubMedGoogle Scholar
  • 9 Motaze NV, Mbuagbaw L, Young T. Prostaglandins before caesarean section for preventing neonatal respiratory distress. Cochrane Pregnancy and Childbirth Group, ed. Cochrane Database of Systematic Reviews. Published online November 11, 2013 DOI: 10.1002/14651858.CD010087.pub2
    Google Scholar
  • 10 Haas DM, Parker CB, Wing DA. et al; NuMoM2b study. A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b). Am J Obstet Gynecol 2015; 212 (04) 539.e1-539.e24
    CrossrefPubMedGoogle Scholar