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Enhancing functional maturity before preterm birth
Mikko Hallman1, Outi Peltoniemi, M Anneli Kari
1Hospital for Children and Adolescents, Oulu University Hospital, Oulu, Finland. mikko.hallman@oulu.fi
Insights
Antenatal glucocorticoids enhance fetal lung maturity, reducing neonatal complications. Repeat courses may pose risks, and their use after 34 weeks requires careful consideration.
Area of Science:
- Perinatology
- Neonatal Medicine
- Fetal Medicine
Background:
- High-risk preterm birth leads to severe neonatal disorders and chronic disease.
- Antenatal glucocorticoids are crucial for fetal lung maturity and reducing neonatal morbidity.
- Surfactant therapy has improved outcomes but prematurity-related issues persist.
Purpose of the Study:
- To review the role of antenatal glucocorticoids in enhancing fetal functional maturity.
- To evaluate the benefits and risks of repeat antenatal glucocorticoid courses.
- To discuss timing and indications for glucocorticoid administration and other prematurity-reducing agents.
Main Methods:
- Review of current literature on antenatal glucocorticoid therapy.
- Analysis of studies on the effects of glucocorticoids and 17alpha-hydroxyprogesterone caproate.
- Evaluation of clinical recommendations for managing preterm birth.
Main Results:
- Antenatal glucocorticoids improve fetal lung maturity and decrease neonatal morbidity.
- Repeat courses may be indicated but carry potential neurological and metabolic risks.
- 17alpha-hydroxyprogesterone caproate reduces prematurity rates but has limited impact on functional maturity.
Conclusions:
- Antenatal glucocorticoids are the primary fetal therapy for reducing prematurity-related neonatal morbidity.
- Careful consideration of timing and repeat courses is essential due to potential adverse effects.
- Delaying elective delivery and individualized treatment are recommended for high-risk pregnancies.
Abstract:
Enhancing functional maturity of the high-risk preterm fetus is aimed at decreasing the life-threatening neonatal disorders that increase the burden of chronic disease. A course of antenatal glucocorticoids before 35 weeks of pregnancy substitutes endogenous activation of the hypothalamic-adrenal axis that spontaneously enhances functional maturity and augments cytokine-induced preterm lung maturity. It is the main fetal therapy that decreases the functional prematurity-related neonatal morbidity in the era of surfactant therapy. Tocolytic agents potentiate the effect of glucocorticoids on the fetus. Repeating an antenatal glucocorticoid course may be recommended if the preterm fetus remains undelivered for more than 7 days and very preterm birth is imminent. However, the follow-up results are still incomplete, and available preliminary studies warn against adverse neurological and metabolic consequences following several antenatal repeat courses of glucocorticoids. Administration of glucocorticoids after 34 weeks of pregnancy may be considered in selected high-risk cases, preferably with documented lung immaturity. We recommend delaying elective delivery in low-risk pregnancies without established lung maturity until 40 weeks, unless labor starts earlier. In a selected high-risk population 17alpha-hydroxyprogesterone acetate decreases the prematurity rate. However, this drug has a limited impact on functional maturity of the preterm fetus and its effects on the development of the child remain to be studied further.
