Child Neurodevelopmental Outcomes After Late Preterm Hypoglycemia.

OBJECTIVE: To evaluate whether hypoglycemia in neonates born to mothers at risk for late preterm delivery was related to adverse effects on childhood neurodevelopment. METHODS: This was a prospective follow-up study of children aged 6 years or older whose mothers were enrolled in the Antenatal Late Preterm Steroids multicenter randomized trial. The study was conducted at 13 centers that participated in the Maternal-Fetal Medicine Units Network cycle from 2011 to 2016. Follow-up was from 2017 to 2022. Adult consent and child assent were obtained. The primary exposure was hypoglycemia , defined as a blood glucose concentration less than 40 mg/dL within 24 hours of birth. The primary outcome, proportion of GCA (General Conceptual Ability) scores lower than 85 (-1 SD) from the DAS-II (Differential Ability Scales, 2nd Edition), was analyzed by the presence of hypoglycemia at birth, irrespective of initial trial treatment assignment (betamethasone or placebo). Secondary outcomes included GMFCS (Gross Motor Function Classification System) level, SRS-2 (Social Responsiveness Scale, 2 nd Edition) scores, and CBCL (Child Behavior Checklist) scores. Univariable and multivariable analyses were performed, the latter adjusted for prespecified variables known to be associated with the primary outcome. RESULTS: Of 1,026 children enrolled, 1,020 (99.4%) had blood glucose data and 944 had data for the primary outcome. Of these 944, 785 (83.2%) were delivered late preterm and 208 (22.0%) had hypoglycemia, of whom 84 (40.4%) were treated. Those with hypoglycemia were more likely to have private insurance, have older mothers, receive betamethasone, and identify as White. There were no differences in the primary outcome, GCA score lower than 85 (15.9% in those with hypoglycemia vs 18.5% in those without; adjusted relative risk 1.03; 95% CI, 0.74-1.45), and no difference in secondary outcomes. Severity of hypoglycemia also was not associated with any outcomes. CONCLUSION: In our cohort, hypoglycemia was not associated with neurodevelopmental outcomes in children born predominantly late preterm.

Duke Scholars

Author Geeta Krishna Swamy Obstetrics and Gynecology, Maternal Fetal Medicine