Impact of antenatal corticosteroid therapy on neonatal respiratory outcomes in late preterm births

This study aimed to evaluate the impact of antenatal corticosteroid therapy (ACT) on neonatal respiratory outcomes in late preterm births, focusing on the interaction between gestational age, mode of delivery, and ACT administration. A retrospective case-control study was conducted on 452 singleton late preterm pregnancies (34 + 0 to 36 + 6 weeks) between 2014 and 2021. Among these, 197 patients received ACT, while 255 did not. Maternal and neonatal characteristics were collected, and logistic regression analyses were performed to identify predictors of neonatal respiratory complications. ACT was associated with a 42% reduction in the odds of neonatal pulmonary complications (adjusted OR: 0.586; 95% CI: 0.347–0.988; p = 0.045). Gestational age was a significant protective factor, with each additional week reducing the risk of adverse pulmonary outcomes by 60% (adjusted OR: 0.397; 95% CI: 0.281–0.561; p < 0.001). Cesarean delivery was associated with a nearly fourfold increase in pulmonary complications compared to vaginal delivery (adjusted OR: 3.775; 95% CI: 1.859–7.666; p < 0.001). ACT showed the most significant protective effect in earlier gestational weeks and among cesarean deliveries. ACT was associated with reduced neonatal pulmonary complications in late preterm pregnancies, particularly among subgroups with earlier gestational age or cesarean delivery, as supported by multivariate and interaction analyses. These findings underscore the importance of individualized antenatal and perinatal management strategies to optimize neonatal outcomes.