Safe Steroid for 23 Weeks Pregnancy
Betamethasone 12 mg intramuscularly in two doses, 24 hours apart, is the safest and most effective corticosteroid for fetal lung maturation at 23 weeks gestation when preterm delivery is anticipated within 7 days. 1
Specific Evidence for 23 Weeks Gestation
At 23 weeks gestation, antenatal corticosteroids significantly reduce death and neurodevelopmental impairment (83.4% vs 90.5%), as well as decrease intraventricular hemorrhage, periventricular leukomalacia, and necrotizing enterocolitis. 1
The benefit at 23 weeks is substantial, though less pronounced than at 24-25 weeks where the reduction in death and neurodevelopmental impairment is even more dramatic (68.4% vs 80.3% at 24 weeks; 52.7% vs 67.9% at 25 weeks). 1
At 22 weeks, no significant benefit was demonstrated (90.2% vs 93.1%), making 23 weeks the earliest gestational age where clear benefit exists. 1
Recommended Dosing Regimen
The standard regimen is betamethasone 12 mg intramuscularly, with a second dose given 24 hours after the first dose. 2, 3, 4
Dexamethasone 12 mg intramuscularly in two doses, 24 hours apart, is an acceptable alternative only if betamethasone is unavailable. 2, 5
Betamethasone is preferred over dexamethasone based on the strongest evidence base from clinical trials. 5
Critical Timing Considerations
Maximum benefit occurs when delivery happens between 24 hours and 7 days after corticosteroid administration. 5
Even if delivery is anticipated in less than 12 hours, corticosteroid administration should still be considered at 23 weeks. 1, 3
The decision to administer corticosteroids at 23 weeks should be based on the family's decision regarding resuscitation, irrespective of membrane rupture status. 6, 7
Absolute Contraindications at 23 Weeks
Do not administer corticosteroids if the patient has pregestational diabetes mellitus, as this significantly increases the risk of severe neonatal hypoglycemia. 1, 3, 5
Gestational diabetes alone is NOT a contraindication—only pregestational diabetes mellitus. 5
Do not administer if there is a low likelihood of delivery before 37 weeks or if resuscitation is not planned. 1
Important Safety Profile
Neonatal hypoglycemia is the primary short-term risk, occurring more frequently with corticosteroid exposure, but 93% of cases resolve within 24 hours and are mild and self-limited. 1, 5
Maternal risks are minimal—corticosteroids do not increase maternal death, chorioamnionitis, or puerperal sepsis. 8
Long-term neurodevelopmental effects remain uncertain, requiring thorough patient counseling about potential risks and benefits. 1, 3
Special Clinical Scenarios at 23 Weeks
Corticosteroids should be administered regardless of membrane rupture status (intact membranes or preterm premature rupture of membranes). 6, 7
Multiple gestations at 23 weeks should receive corticosteroids if at risk of delivery within 7 days. 6, 7
Patients with pregnancy-related hypertension syndromes should receive corticosteroids, as antenatal corticosteroid use is effective in these conditions. 8
Common Pitfalls to Avoid
Do not withhold treatment based on uncertainty about exact delivery timing—if there is genuine high risk of delivery within 7 days at 23 weeks, administer corticosteroids. 5
Do not delay administration waiting for "better" gestational age—23 weeks represents a critical window where intervention significantly improves outcomes. 1, 9
Do not administer multiple courses routinely—the evidence clearly supports only a single course at this gestational age. 4
Tocolysis during steroid administration is not routinely indicated in the absence of contractions, cervical shortening, or rupture of membranes. 4