Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

Area of Science:

• Obstetrics and Gynecology
• Neonatology
• Perinatal Medicine

Background:

• Antenatal corticosteroid administration is established for preterm births before 34 weeks gestation.
• A recent advisory suggests considering betamethasone for singleton pregnancies between 34-37 weeks at imminent risk of preterm birth.
• Uncertainties persist regarding the risks and benefits of antenatal corticosteroids in this late preterm population.

Purpose of the Study:

• To review the literature on antenatal corticosteroid use in late preterm infants (34-37 weeks gestation).
• To evaluate the benefits against potential risks and unknowns.
• To inform clinical practice and guide future research.

Main Methods:

• Literature review of studies on antenatal corticosteroids in late preterm infants.
• Analysis of benefits, such as reduction in transient tachypnea of the newborn.
• Assessment of potential risks including neonatal hypoglycemia and long-term neurodevelopmental outcomes.

Main Results:

• The primary benefit observed is a reduction in transient tachypnea of the newborn, a largely self-limited condition.
• Potential risks include neonatal hypoglycemia and unknown long-term neurodevelopmental and metabolic effects.
• Late preterm infants may still experience other prematurity-related complications requiring intensive care.

Conclusions:

• Caution is advised before widespread adoption of antenatal corticosteroids for late preterm births due to unclear long-term effects.
• The benefits of reducing transient tachypnea must be weighed against potential adverse outcomes.
• Further research is crucial for a balanced understanding of risks and benefits, improved prediction of preterm birth, and long-term follow-up.