Recent data also suggest that betamethasone can be beneficial in pregnant women at high risk of late preterm birth, between 34 0/7 weeks and 36 6/7 weeks of gestation who have not received a prior course of antenatal corticosteroids. The Maternal Fetal Medicine Units (MFMU) Network Antenatal Late Preterm Steroids trial ( 24 ) was a double-blind, placebo-controlled, randomized clinical trial designed to evaluate the use of antenatal betamethasone for pregnant women at high risk of delivery in the late preterm period. Women were identified to be at high risk if they presented in preterm labor, had preterm PROM, or if they had a planned delivery in the late preterm period, with the indication at the discretion of the obstetrician–gynecologist or other health care provider. Tocolysis was not employed as a part of this trial, and delivery was not delayed for obstetric or medical indications. The study found that the administration of betamethasone led to a significant decrease in the primary outcome, which was the need for respiratory support. A larger decrease was demonstrated for severe respiratory complications, from % in the placebo group to % in the betamethasone group (RR, ; 95% CI, –; P <.001). There were also significant decreases in the rates of transient tachypnea of the newborn; bronchopulmonary dysplasia; a composite of respiratory distress syndrome (RDS), transient tachypnea of the newborn and RDS; and the need for postnatal surfactant. Infants exposed to betamethasone were less likely to require immediate postnatal resuscitation. There was no increase in proven neonatal sepsis, chorioamnionitis, or endometritis with late preterm betamethasone. Hypoglycemia was more common in the infants exposed to betamethasone % versus % (RR, ; 95% CI, –); however, there were no reported adverse events related to hypoglycemia, which was not associated with an increased length of hospital stay. The rates of hypoglycemia found in the trial are similar to what is reported in the general population of late preterm infants ( 25 ). Although not studied in this trial, long-term adverse outcomes of prolonged and persistent neonatal hypoglycemia have been described ( 26 , 27 ). In order to reduce this risk and achieve the benefits of betamethasone therapy for fetal maturity in late preterm pregnancies, the American Academy of Pediatrics’ guidelines should be followed when employing this therapy (27). The American Academy of Pediatrics recommends the monitoring of neonatal blood sugars for late preterm infants because late preterm birth is a known risk factor for hypoglycemia. A single course of betamethasone is recommended for pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids (24, 28 ).
Call for Personal Stories: Numerous stories have documented people facing bias and prejudice in public spaces. These stories include aggressive and prejudicial behavior levied at obstetricians and gynecologists. Such events are painful and can prevent the recipient of such behavior from doing their job, increase the risk of professional burnout, and evoke anger and depression. In response, Obstetrics & Gynecology is planning to publish a featured section on biases encountered by ob-gyns in the workplace.
To accurate ly represent our workforce, the Editors are seeking your personal story if you have faced or are currently facing bias in your role as a practicing physician or have observed this kind of behavior. The perpetrator may be a boss or supervisor, a colleague, a patient or patient family member, or someone else in your work life. The behavior can be overt or subtle. You may be facing biases due to your race, sex, national origin, religion, sexual orientation, gender expression, age, or physical ability. Or maybe something that we’ve not considered.
There are no guidelines for these stories. Your contribution, if used, will be presented anonymously: any identifying information will remain confidential. Your story, if chosen, will be excerpted by the Editors and published in an article with the intent of shedding light on the personal experiences of ob-gyns. This article will be part of larger series to address the issue of bias in our field. All stories will remain anonymous and authors will be notified by the Editors if their piece is selected for inclusion in the article.
Please share your story at supplement@ . For any clarifying questions prior to submission, please contact Rebecca Benner, Managing Editor, at 202-314-2340. Members of the advisory board for this featured section include Nancy Chescheir, MD, Kemi Doll, MD, Kacey Eichelberger, MD, Verda Hicks, MD, and Ashish Premkumar, MD.
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