To establish the expected range of maternal leukocytosis in healthy pregnant women without infection after antenatal corticosteroid administration.METHODS:
PubMed, Embase, and ClinicalTrials.gov were searched to identify studies that reported white blood cell (WBC) counts in healthy women with singleton gestations without signs of clinical infection preceding and after antenatal corticosteroid administration at 24, 48, 72, and/or 96 hours. The mean, standard deviation, and two standard deviations from the mean were reported. The inverse variance weighting technique was used to calculate weighted means, as well as one and two standard deviations from the mean to determine the expected range of WBC count for each time period.RESULTS:
Eight studies met inclusion criteria (695 patients and 1,748 data points). Mean maternal WBC count values prior to antenatal corticosteroid administration and 24, 48, 72, and 96 hours after corticosteroid administration were 10.4, 13.7, 12.8, 11.5, and 11.1×109/L, respectively. A subset of patients with preterm premature rupture of membranes (PPROM) had mean WBC count values prior to corticosteroid administration and 24 and 48 hours after corticosteroid administration of 10.0, 13.8, and 13.0×109/L. The highest second standard deviation from the mean was 18.3×109/L, which occurred at 24 hours after antenatal corticosteroid administration.CONCLUSION/IMPLICATIONS:
Leukocytosis mean peaks at 24 hours after corticosteroid administration. The highest second standard deviation from the mean was 18.3×109/L. More studies are required to determine if further infectious workup is warranted in women receiving antenatal corticosteroids when WBC values are outside of this range.