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Recommendations for repeat courses of antenatal corticosteroids: a decision analysis
Aaron B Caughey1, Julian T Parer
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco 94143-0550, USA.
American Journal of Obstetrics and Gynecology
|June 18, 2002
Summary
A single course of antenatal corticosteroids (ACS) is insufficient for preterm delivery risk. The optimal regimen involves a maximum of two ACS courses, given every other week, to reduce respiratory distress syndrome without increasing neonatal deaths.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Pharmacology
Background:
- Antenatal corticosteroids (ACS) are crucial for fetal lung maturation.
- Evidence on optimal dosing for multiple ACS courses is evolving.
- Balancing benefits against potential harms of repeated ACS is critical.
Purpose of the Study:
- To review evidence on single versus multiple ACS courses.
- To develop and compare five distinct ACS dosing regimens.
- To identify the safest and most effective ACS strategy for preterm delivery.
Main Methods:
- Literature review for ACS dose-response data.
- Decision analysis model using odds ratios and risks.
- Mathematical modeling for preterm delivery risk and gestational age.
- Sensitivity analysis to address data uncertainties.
Main Results:
- An estimated 138,000 fetuses annually are at risk for preterm delivery (24-34 weeks).
- A single ACS course leads to 30,232 cases of respiratory distress syndrome (RDS) and 4032 neonatal deaths.
- Regimen 4 (every-other-week dosing, max 2 courses) reduced RDS by 2187 cases without increasing neonatal deaths.
Conclusions:
- Multiple ACS doses may decrease RDS but can increase neonatal mortality.
- Recommended regimen: initial ACS course, followed by a second course 2 weeks later if risk persists, with a maximum of two courses.
- Further validation through randomized controlled trials is necessary.