Graeme N Smith1, Yanfang Guo, Shi Wu Wen, Mark C Walker. 1. Department of Obstetrics and Gynecology, Queen's Perinatal Research Unit, Kingston General Hospital, Queen's University, Kingston, ON, Canada. gns@queensu.ca.
Abstract
OBJECTIVE: This secondary analysis of a randomized placebo-controlled trial was to hypothesize on mechanisms for the improved neonatal outcomes with the use of nitroglycerin (GTN) for preterm labor. STUDY DESIGN:Women in the original trial who delivered at term were excluded. A composite of severe neonatal outcomes, gestational age at delivery, and corticosteroid use in addition to Kaplan-Meier survival analysis to assess time from randomization to delivery were examined. RESULTS: A decrease in composite neonatal outcome (relative risk, 0.21; 95% confidence interval, 0.05-0.81; P = .018) with GTN (n = 39) compared with placebo (n = 38) was primarily due to a 23 day prolongation of pregnancy (P = .019) and a trend (P = .04) toward completing a course of corticosteroids in the subgroup randomized prior to 28 weeks' gestation. CONCLUSION: We hypothesize that GTN has a gestational age-dependent reduction in neonatal outcomes as a result of pregnancy prolongation and corticosteroid administration.
RCT Entities:
OBJECTIVE: This secondary analysis of a randomized placebo-controlled trial was to hypothesize on mechanisms for the improved neonatal outcomes with the use of nitroglycerin (GTN) for preterm labor. STUDY DESIGN:Women in the original trial who delivered at term were excluded. A composite of severe neonatal outcomes, gestational age at delivery, and corticosteroid use in addition to Kaplan-Meier survival analysis to assess time from randomization to delivery were examined. RESULTS: A decrease in composite neonatal outcome (relative risk, 0.21; 95% confidence interval, 0.05-0.81; P = .018) with GTN (n = 39) compared with placebo (n = 38) was primarily due to a 23 day prolongation of pregnancy (P = .019) and a trend (P = .04) toward completing a course of corticosteroids in the subgroup randomized prior to 28 weeks' gestation. CONCLUSION: We hypothesize that GTN has a gestational age-dependent reduction in neonatal outcomes as a result of pregnancy prolongation and corticosteroid administration.
Authors: Amie Wilson; Victoria A Hodgetts-Morton; Ella J Marson; Alexandra D Markland; Eva Larkai; Argyro Papadopoulou; Arri Coomarasamy; Aurelio Tobias; Doris Chou; Olufemi T Oladapo; Malcolm J Price; Katie Morris; Ioannis D Gallos Journal: Cochrane Database Syst Rev Date: 2022-08-10