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Repeat prenatal corticosteroids: who still recommends their use and why?
Kristin J McLaughlin1, Caroline A Crowther
1Department of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, Adelaide, South Australia, Australia. kristin.mclaughlin@adelaide.edu.au
The Australian & New Zealand Journal of Obstetrics & Gynaecology
|January 10, 2004
Summary
Fewer obstetricians and neonatologists now recommend repeat prenatal corticosteroids, despite their widespread use. Evidence sources influencing these clinical decisions vary significantly between specialties and practitioners.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Perinatal Medicine
Background:
- Repeat prenatal corticosteroid use is common globally, contrasting with NIH recommendations to reserve it for clinical trials due to insufficient benefit-to-risk data.
- The study addresses the discrepancy between common practice and expert recommendations regarding repeat antenatal corticosteroid therapy.
Purpose of the Study:
- To assess current obstetrician and neonatologist recommendations for repeat prenatal corticosteroids.
- To investigate the evidence base influencing these clinical practices.
Main Methods:
- A postal questionnaire survey was conducted in August-September 2001.
- The survey targeted obstetricians and neonatologists in Australia and New Zealand.
- Practitioner use, recommendations, and evidence sources for repeat prenatal corticosteroids were assessed.
Main Results:
- 44% of obstetricians and 21% of neonatologists recommended repeat prenatal corticosteroids.
- Obstetricians were twice as likely to recommend repeat courses compared to neonatologists.
- Over half of respondents (57%) had altered their recommendations in the prior three years.
- Evidence sources differed between specialties and between those who recommended and those who did not recommend repeat courses.
Conclusions:
- Current recommendations for repeat prenatal corticosteroids are lower than in previous surveys.
- Discrepancies exist in the evidence sources guiding obstetrician and neonatologist practices regarding repeat antenatal corticosteroid use.
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