From the Guidelines
Antenatal corticosteroids are generally safe for the fetus and neonate, with no increased risk of neurologic impairment or long-term neurodevelopmental effects after a single course of treatment.
Benefits and Risks
The benefits of antenatal corticosteroids in reducing neonatal morbidity, including respiratory distress syndrome, intraventricular hemorrhage, and sepsis, are well established 1. However, the long-term risks associated with antenatal corticosteroid use remain uncertain.
- Reduced neonatal morbidity: Antenatal corticosteroids have been shown to decrease the composite outcome of need for respiratory support and severe respiratory morbidity composite outcome 1.
- No increased risk of neurologic impairment: Follow-up studies from RCTs of antenatal corticosteroids have found no increased risk of neurologic impairment in children born after exposure to a single course of antenatal corticosteroids 1.
Special Considerations
- Multiple courses of antenatal corticosteroids: Different outcomes have been observed after multiple courses of antenatal corticosteroids, and the use of multiple courses is not recommended without further research 1.
- Pregestational diabetes mellitus: The use of antenatal corticosteroids is not recommended in pregnant patients with pregestational diabetes mellitus due to the risk of worsening neonatal hypoglycemia 1.
- Twin late preterm birth: There is a paucity of information on the effectiveness of antenatal corticosteroids in twin late preterm birth, and guidelines are not yet established in this population 1.
Recommendations
The Society for Maternal-Fetal Medicine recommends offering a single course of antenatal corticosteroids to patients who meet the inclusion criteria of the Antenatal Late Preterm Steroids trial, and suggests consideration for the use of antenatal corticosteroids in select populations not included in the original trial 1.
From the Research
Complications of Antenatal Corticosteroids on the Fetus and Neonate
- The use of antenatal corticosteroids has been shown to reduce the risk of respiratory distress syndrome (RDS) 2, 3, 4, neonatal death 2, 3, 4, and intraventricular hemorrhage (IVH) 2, 3, 4 in preterm infants.
- Antenatal corticosteroids have also been found to reduce the risk of necrotising enterocolitis 2, cerebroventricular haemorrhage 2, and systemic infections in the first 48 hours of life 2.
- However, the optimal timing of antenatal corticosteroid administration is uncertain, with some studies suggesting that administration 2 to <7 days before delivery may be associated with the lowest risks of neonatal and childhood morbidity 5.
- Antenatal corticosteroid administration ≥14 days before delivery may be associated with an increased odds of severe neonatal and childhood morbidity, compared to 2 to <7 days before delivery 5.
- The evidence from these studies supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth 2, 3, 4.
- The use of antenatal corticosteroids is effective in women with premature rupture of membranes and pregnancy-related hypertension syndromes 2.
- Further research is needed to investigate the long-term effects of antenatal corticosteroids on the child in later life 2, 4.
Maternal Outcomes
- Antenatal corticosteroids do not increase the risk of maternal death, chorioamnionitis, or puerperal sepsis 2.
- The use of antenatal corticosteroids may result in little to no difference in maternal death, chorioamnionitis, and endometritis 4.
Neonatal Outcomes
- Antenatal corticosteroids reduce the risk of perinatal death, neonatal death, and RDS in preterm infants 2, 3, 4.
- Antenatal corticosteroids probably reduce the risk of IVH and have little to no effect on birthweight 4.
- Antenatal corticosteroids probably lead to a reduction in developmental delay in childhood 4.