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News|Articles|May 29, 2024

Tocolysis use after PPROM not linked to neurodevelopmental outcomes

A recent study investigated the effects of antenatal tocolysis on neurodevelopmental outcomes among children aged 5.5 years following preterm prelabor rupture of membranes, revealing no significant differences in outcomes.

Neurodevelopmental outcomes among children aged 5.5 years do not differ based on antenatal tocolysis exposure following preterm prelabor rupture of membranes (PPROM), according to a recent study in the American Journal of Obstetrics & Gynecology.1

Takeaways

  1. The study finds no notable variance in neurodevelopmental outcomes among children aged 5.5 years based on antenatal exposure to tocolysis following preterm prelabor rupture of membranes (PPROM), indicating its limited impact on long-term developmental trajectories.
  1. Despite controversies surrounding the use of tocolysis post-PPROM, researchers emphasize the need for evidence-based decision-making regarding its administration in pregnant individuals.
  1. Conducted as a prospective, population-based birth cohort study in France, the research encompasses a broad spectrum of maternal, neonatal, and obstetrical factors, providing a robust framework for evaluating outcomes.
  1. With over 700 children included in the analysis, the study reports survival rates without moderate to severe neurodevelopmental disabilities at 5.5 years, indicating no significant association with antenatal tocolysis exposure.
  1. The findings underscore the importance of carefully weighing the risks and benefits of tocolytic administration post-PPROM, suggesting a nuanced approach in treatment decision-making for pregnant individuals to optimize maternal and fetal outcomes.

Three percent of pregnancies are impacted by PPROM, which is behind 1 in 3 preterm births and is a leading cause of neonatal morbidity and mortality. Current management practices are recommended to be utilized before 34 weeks’ gestation.

When PPROM occurs at 34 to 37 weeks’ gestation, induction of labor is recommended.2 However, PPROM before 34 weeks can lead to severe outcomes. Management strategies include antibiotics to prevent infection and steroids to support fetal lung development, with patients closely monitored to determine when labor can be induced.

There is controversy surrounding the use of a short-term tocolysis following PPROM.1 Researchers have hypothesized delayed delivery and improved antenatal management following reduced uterine contractility, but concerns have arisen that tocolysis could impact the fetal brain or lead to intrauterine infection or inflammation.

To determine the impact of tocolytic administration following PPROM on neurodevelopmental outcomes when aged 5.5 years, investigators conducted a prospective, population-based birth cohort study. Births from 22 to 34 weeks’ gestation in France in 2011 were included in the analysis.

Survivors from the initial study were invited to participate in the follow-up at 5.5 years, with maternal, neonatal, and obstetrical data obtained from medical records. Additional data was obtained from self-administered questionnaires completed by parents and clinical examinations and cognitive assessments of children performed by trained professionals.

Eligibility criteria included PPROM at 24 to 32 weeks’ gestation and a live fetus during PPROM at 24 to 34 weeks’ gestation. Exclusion criteria included multiple pregnancy, termination of pregnancy, home birth, fetal death before maternal hospital admission, lethal malformations, and precursor to delivery besides PPROM.

Tocolytic administration following PPROM diagnosis was defined as the primary exposure of the analysis, while the primary outcome was survival without moderate to severe neurodevelopmental disabilities at age 5.5 years. Survival was reported as the number of living children at 5.5 years vs the number of living fetuses at PPROM.

Covariates included maternal age, education, country of birth, parental socioeconomic position, uterine contractions at admission, parity, PPROM before hospitalization, gestational age at PPROM, fetal sex, presentation, birth weight, in utero transfer antenatal steroid or antibiotic administration, and maternity unit type.

There were 712 living children included in the final analysis. Women receiving tocolysis more often had uterine contractions and in-utero transfer.

Survival without moderate to severe neurodevelopmental disabilities was reported in 82.7% of the tocolysis group and 82.5% of the no tocolysis group. Living without any disabilities was reported by 52.7% and 51.1%, respectively.

No association was found between tocolysis exposure and survival without moderate to severe developmental disabilities, with an odds ratio of 0.93. Following antenatal exposure to oxytocin receptor antagonists and calcium channel blockers, rates were 80.7% and 83.7%, respectively.

These results indicated no association between antenatal tocolysis exposure and neurodevelopmental outcomes at age 5.5 years. Investigators concluded utilization of tocolytics after PPROM should be considered when deciding the best treatment strategy for a pregnant individual.

Reference

  1. Lorthe E, Machand-Martin L, Letouzey M, et al. Tocolysis after preterm prelabor rupture of membranes and 5-year outcomes: a population-based cohort study. Am J Obstet Gynecol. 2024;230:570.e1-18. doi:10.1016/j.ajog.2023.10.010
  2. Premature rupture of membranes. Mount Sinai. Accessed May 29, 2024. https://www.mountsinai.org/health-library/special-topic/premature-rupture-of-membranes.

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