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Prenatal thyrotropin-releasing hormone for preterm birth
C A Crowther1, Z Alfirevic, R R Haslam
1Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, South Australia, Australia, SA 5006. ccrowthe@medicine.adelaide.edu.au
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Adding prenatal thyrotropin-releasing hormone (TRH) to corticosteroids does not improve outcomes for very preterm infants and may increase risks. This combination therapy is not recommended for preventing neonatal respiratory disease.
Area of Science:
- Neonatal Medicine
- Obstetrics
- Pharmacology
Background:
- Prenatal corticosteroids are used to enhance fetal lung development.
- Thyrotropin-releasing hormone (TRH) has been investigated as an adjunct therapy.
Purpose of the Study:
- To review the efficacy of prenatal TRH combined with corticosteroids for preventing neonatal respiratory disease in women at risk of very preterm birth.
Main Methods:
- Systematic review of randomized controlled trials comparing prenatal TRH plus corticosteroids versus corticosteroids alone or with placebo.
- Searches conducted up to January 1999, including Cochrane databases.
- Outcomes assessed included fetal/neonatal mortality, neonatal morbidity, childhood development, and maternal morbidity.
Main Results:
- Over 4500 women in 11 trials; 5 high-quality.
- Prenatal TRH with corticosteroids did not reduce neonatal respiratory disease or improve other assessed outcomes.
- TRH was associated with increased maternal side effects and adverse infant outcomes, including increased need for ventilation and lower Apgar scores.
Conclusions:
- Current evidence does not support the use of prenatal TRH in addition to corticosteroids for women at risk of very preterm birth.
- This combination therapy is not recommended for clinical practice due to lack of benefit and potential harm.