Controversies in antenatal corticosteroids.

Area of Science:

• Obstetrics and Neonatology
• Pharmacology
• Translational Medicine

Background:

• Antenatal corticosteroids (ACS) are crucial for improving neonatal outcomes following preterm birth.
• Despite proven benefits, contemporary use of ACS is associated with several controversies and uncertainties.

Purpose of the Study:

• To explore current controversies surrounding antenatal corticosteroid administration.
• To discuss optimal use in specific gestational ages and populations.
• To identify future research priorities for individualizing ACS therapy.

Main Methods:

• Literature review and synthesis of current evidence on antenatal corticosteroids.
• Analysis of controversies including corticosteroid choice, timing, and dosing strategies.
• Discussion of ACS use in special populations and before cesarean delivery.

Main Results:

• Controversies exist regarding the optimal choice of corticosteroid, use in very early and late preterm birth, and before term cesarean delivery.
• Repeated and rescue dosing strategies require further clarification.
• Individualizing ACS therapy remains a key area for future research.

Conclusions:

• Antenatal corticosteroids are a cornerstone of preterm birth management, but optimal application requires addressing current controversies.
• Further research is needed to refine dosing, timing, and patient selection for ACS to maximize benefits and minimize potential risks.
• Individualized therapy holds promise for optimizing antenatal corticosteroid treatment.