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Review
. 2024 Nov 29;16(11):e74763.
doi: 10.7759/cureus.74763. eCollection 2024 Nov.

Impact of Antenatal Corticosteroids on Cortisol and Glucose Homeostasis Levels in Preterm Neonates: A Meta-Analysis

Prerana S Bharadwaj  1 , Srikrishna V Acharya  1
Affiliations
Review

Impact of Antenatal Corticosteroids on Cortisol and Glucose Homeostasis Levels in Preterm Neonates: A Meta-Analysis

Prerana S Bharadwaj et al. Cureus. .

Abstract

Antenatal corticosteroids (ACS) are widely used to reduce respiratory distress syndrome (RDS) in preterm neonates, enhancing neonatal outcomes. However, the potential effects of ACS on other aspects of neonatal health, such as cortisol levels and glucose regulation, remain a concern. This study examines whether ACS administration impacts cortisol and glucose homeostasis in preterm infants by analyzing data from 14 selected studies. Using a random-effects model, we found no significant impact of ACS on cortisol levels (mean differences (MD) 2.23, confidence interval (CI) 5.26 to -0.80) or blood glucose levels (standard mean differences (SMD) 0.18, CI 0.00 to 0.35). Additionally, there was no notable difference in hypoglycemia risk between groups receiving ACS and those unexposed (odds ratio (OR) 1.46, CI 0.99 to 2.17). Subgroup and sensitivity analyses reinforced these findings, underscoring their robustness, and risk-of-bias assessment confirmed a low risk across the included studies. Our findings support the safety of ACS for cortisol and glucose levels in preterm infants, affirming its continued use for lung development while recommending vigilant blood glucose monitoring to manage potential hypoglycemia. These results provide essential insights for neonatal care protocols, contributing to the overall welfare of premature infants.

Keywords: antenatal corticosteroids; blood-glucose; cortisol; hypoglycemia risk; preterm neonate.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart summarizing the literature search
Figure 2
Figure 2. Cortisol level outcome between ACS exposure group and no ACS exposure group
ACS: antenatal corticosteroids [17-22]
Figure 3
Figure 3. Hypoglycemia outcome between ACS exposure group and no ACS exposure group
ACS: antenatal corticosteroids [23-29]
Figure 4
Figure 4. Blood glucose outcome between ACS exposure group and no ACS exposure group
ACS: antenatal corticosteroids [21,27,4]
Figure 5
Figure 5. Hypoglycemia outcome between ACS complete course group and ACS partial course group
ACS: antenatal corticosteroids [25,27]
Figure 6
Figure 6. Blood glucose outcome between ACS complete course group and ACS partial course group
ACS: antenatal corticosteroids [27,4]
Figure 7
Figure 7. Hypoglycemia outcome between ACS partial course group and no ACS group
ACS: antenatal corticosteroids [25,27]
Figure 8
Figure 8. Cortisol outcome between ACS complete course group and no ACS group
ACS: antenatal corticosteroids [18-20,22]
Figure 9
Figure 9. Hypoglycemia outcome between ACS complete course group and no ACS group
ACS: antenatal corticosteroids [25,27]
Figure 10
Figure 10. Blood glucose outcome between ACS complete course group and no ACS group
ACS: antenatal corticosteroids [27,4]
Figure 11
Figure 11. Cortisol outcome with subgroup based on the difference of time sampling
ACS: antenatal corticosteroids At delivery: [17,19,21,22]; At certain times: [18,20]
Figure 12
Figure 12. Hypoglycemia outcome with subgroup based on the difference of time sampling
ACS: antenatal corticosteroids Hypoglycemia within 48 hours: [24-26,29]; Hypoglycemia within 72 hours: [23,27,28]
Figure 13
Figure 13. Focused sensitivity analysis of hypoglycemia outcome
ACS: antenatal corticosteroids [27,29]
Figure 14
Figure 14. Studies quality assessment using ROBINS-I
ROBINS-I: Risk of Bias In Non-randomized Studies - of Interventions [24,27,28,23,18,22,29,19,4,20,26,25,21]
Figure 15
Figure 15. Overall risk of bias - summary of domains
See this image and copyright information in PMC

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