Understanding Individualized Risk of Respiratory Morbidity to Guide Shared Decision-Making Around Late Preterm Steroids

Abstract Objective To estimate the effect of antenatal steroids on the absolute risk of respiratory morbidity among subgroups of patients based on two clinical factors with known varying baseline risks of morbidity: planned mode of delivery and gestational age at presentation.Methods This is a secondary analysis of the Antenatal Late Preterm Steroid (ALPS) Trial, a study that randomized individuals at high risk for late preterm delivery (34-36 weeks of gestation) to antenatal steroids or placebo. We fit logistic regression models to estimate the absolute 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 homogenous effect of steroids on the log-odds scale, as was reported in the ALPS trial. To aid in shared decision-making, we report absolute risks of neonatal respiratory complications with and without steroid administration graphically, in tabular form, and via an online tool available at XXX.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 odds ratio (aOR) 2.19 (95% confidence interval (CI) 1.68, 2.85) for cesarean compared to vaginal delivery) and day of gestation at presentation (aOR 0.91 (95% CI 0.89, 0.93)). For those planning a cesarean delivery and presenting in the 34th week of gestation, the risk of neonatal respiratory morbidity was 36.7% (95% CI 29.8, 43.7%) without steroids and 31.4% (95% CI 24.5, 37.9%) with steroids. In contrast, for patients presenting in the 36th week and planning a vaginal delivery, the risk of neonatal respiratory morbidity was 6.8% (95% CI 5.1, 8.5%) without steroids and 5.4% (95% 4.0, 6.9%) with steroids.Conclusion The absolute risk of neonatal respiratory morbidity among patients at risk for late preterm delivery varies considerably by gestational age at presentation and planned mode of delivery. As communicating only the relative risk reduction of antenatal steroids for respiratory morbidity may exaggerate the perception of benefit, especially for those with a small absolute risk, individualized estimates of absolute risk expected with and without treatment may inform shared decision-making..

Medienart:	Preprint

Erscheinungsjahr:	2024
Erschienen:	2024

Enthalten in:	bioRxiv.org - (2024) vom: 10. Jan. Zur Gesamtaufnahme - year:2024

Sprache:	Englisch

Beteiligte Personen:	Clapp, Mark A. [VerfasserIn] Li, Siguo [VerfasserIn] Cohen, Jessica L. [VerfasserIn] Gyamfi-Bannerman, Cynthia [VerfasserIn] Kaimal, Anjali J. [VerfasserIn] Knudsen, Amy B. [VerfasserIn] Lorch, Scott A [VerfasserIn] Thaweethai, Tanayott [VerfasserIn] Wright, Jason D. [VerfasserIn] Melamed, Alexander [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	570 Biology

doi:	10.1101/2024.01.04.23299873

funding:
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PPN (Katalog-ID):	XBI042125235