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Multiple courses of antenatal steroids: risks and benefits
A Walfisch1, M Hallak, M Mazor
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Obstetrics and Gynecology
|September 1, 2001
Summary
Multiple courses of antenatal corticosteroids may not improve outcomes for preterm infants and raise concerns for adverse effects. A single course is recommended for women at risk for preterm birth.
Area of Science:
- Perinatal Medicine
- Neonatal Research
- Obstetrics
Background:
- Antenatal corticosteroids are used to mature fetal lungs and reduce complications of prematurity.
- The optimal dosing regimen, particularly regarding multiple courses, remains under investigation.
Purpose of the Study:
- To systematically review the literature on the efficacy and safety of multiple courses of antenatal corticosteroids.
- To evaluate the impact on complications related to lung immaturity in preterm neonates.
Main Methods:
- Systematic review of English-language human and animal studies.
- Searched MEDLINE and PubMed databases using terms: antenatal steroids, prenatal steroids, respiratory distress syndrome.
- Included prospective animal studies and human studies (primarily retrospective) addressing outcomes of multiple corticosteroid courses.
Main Results:
- Animal studies suggest adverse effects: decreased birth/lung weights, restricted brain growth.
- Human studies (limited by methodology) indicate potential benefits (reduced respiratory distress syndrome, oxygen use) but also adverse outcomes (reduced head circumference/birth weight, increased infection rates).
- No well-designed human randomized controlled trials (RCTs) support multiple courses over a single course.
Conclusions:
- Current evidence lacks strong support for multiple antenatal corticosteroid courses in humans.
- Growing evidence suggests potential adverse consequences from repeated courses.
- A single course of antenatal corticosteroids is recommended for women at risk for preterm birth between 24-34 weeks gestation, pending results from ongoing RCTs.