What are the dosing recommendations for Dexamethasone (corticosteroid) and Betamethasone (corticosteroid) peripartum?

From the Guidelines

For peripartum corticosteroid administration to promote fetal lung maturity, the recommended regimen is betamethasone 12 mg intramuscularly given as two doses 24 hours apart, as supported by the most recent and highest quality study 1.

Key Considerations

• The administration of antenatal corticosteroids has been widely adopted as the standard of care in the management of pregnancies at risk for preterm delivery before 37 weeks of gestation, with the primary goal of reducing neonatal morbidity 1.
• The recommended regimen of betamethasone is specifically for patients with a singleton pregnancy between 34 0/7 and 36 6/7 weeks of gestation who are at high risk of preterm birth within the next 7 days and before 37 weeks of gestation (GRADE 1A) 1.
• Dexamethasone may also be considered, but the provided evidence does not specify its use in the same context as betamethasone for peripartum administration to promote fetal lung maturity in the late preterm period 1.

Benefits and Risks

• The benefits of antenatal corticosteroids include a decrease in the composite outcome of need for respiratory support and a decrease in the severe respiratory morbidity composite outcome 1.
• The risks associated with antenatal corticosteroid use, particularly in the context of pregestational diabetes mellitus, include worsening neonatal hypoglycemia, and thus, their use is recommended against in such cases (GRADE 1C) 1.

Clinical Decision Making

• Clinicians should consider the use of antenatal corticosteroids in select populations not included in the original Antenatal Late Preterm Steroids trial, such as patients with multiple gestations reduced to a singleton gestation on or after 14 0/7 weeks of gestation, patients with fetal anomalies, or those who are expected to deliver in <12 hours (GRADE 2C) 1.
• Patients at risk for late preterm delivery should be thoroughly counseled regarding the potential risks and benefits of antenatal corticosteroid administration and be advised that the long-term risks remain uncertain (GRADE 1C) 1.

From the FDA Drug Label

The initial dosage of parenterally administered Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension may vary from 0.25 to 9 mg per day depending on the specific disease entity being treated. In certain overwhelming, acute, life-threatening situations, administrations in dosages exceeding the usual dosages may be justified and may be in multiples of the oral dosages For the treatment of acute exacerbations of multiple sclerosis, daily doses of 30 mg of betamethasone for a week followed by 12 mg every other day for 1 month are recommended The range of initial doses is 0.02 to 0.3 mg/kg/day in three or four divided doses (0.6 to 9 mg/m2bsa/day) for pediatric patients

Dosing Recommendations for Dexamethasone and Betamethasone peripartum:

• There is no specific information in the provided drug labels regarding dosing recommendations for Dexamethasone and Betamethasone peripartum.
• The provided drug labels discuss various dosing regimens for different conditions, but do not address peripartum dosing specifically.
• No conclusion can be drawn regarding the dosing recommendations for Dexamethasone and Betamethasone peripartum based on the provided information 2, 3.

From the Research

Dosing Recommendations for Dexamethasone and Betamethasone Peripartum

• The current treatment regimens for antenatal corticosteroids, such as dexamethasone and betamethasone, may be suboptimal, with concerns raised regarding possible adverse long-term neurological outcomes due to high fetal drug exposures 4.
• A study suggested that for betamethasone, a dose reduction from 2 dosages of 11.4 mg, 24 hours apart, to 4 dosages of 1.425 mg, 12 hours apart, would avoid excessive peak exposures and still meet the fetal response threshold 4.
• For dexamethasone, the dose may be reduced from 4 times 6 mg every 12 hours to 8 times 1.5 mg every 6 hours 4.
• Another study compared the effect of two-dose administration of betamethasone with 12 hours interval vs. 24 hours interval on neonatal respiratory distress syndrome, and found that 12 hours interval betamethasone therapy may be considered as an alternative treatment in the case of preterm labor for acceleration of lung maturity 5.
• A randomized trial found that administration of antenatal dexamethasone or betamethasone to women at risk of preterm birth improved infant survival and health, with no significant difference in the incidence of death or neurosensory disability at age 2 years between the two groups 6.
• A study using a sheep model of pregnancy found that a low-dose antenatal betamethasone treatment achieved preterm lung maturation equivalent to that of the World Health Organization dexamethasone regimen, but with reduced endocrine disruption 7.

Comparison of Dexamethasone and Betamethasone Regimens

• A study compared the effects of dexamethasone and betamethasone on preterm lung maturation and found that both regimens achieved equivalent improvements in lung function, but with smaller perturbations to the maternofetal hypothalamic-pituitary-adrenal axis in the betamethasone group 7.
• The study suggested that a betamethasone dose of 2 mg may remain above the minimum dose necessary for robust maturation of the preterm lung, and that maternal weight-adjusted betamethasone doses might be a key to reducing perturbations to the maternofetal hypothalamic-pituitary-adrenal axis 7.

Clinical Implications

• The findings of these studies suggest that lower doses of antenatal corticosteroids, such as dexamethasone and betamethasone, may be effective in preventing neonatal respiratory distress syndrome while minimizing adverse effects on the fetus and mother 4, 6, 5, 7.
• Further research is needed to confirm the effectiveness and safety of lower doses of antenatal corticosteroids and to determine the optimal dosing regimens for different patient populations 4, 7.