Controversies in antenatal corticosteroid treatment

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Pharmacology

Background:

• Antenatal corticosteroids are a cornerstone therapy for preventing neonatal morbidity and mortality associated with preterm birth.
• Despite widespread acceptance, significant controversies and knowledge gaps persist regarding their optimal use.
• Evidence from randomized controlled trials is lacking for specific populations.

Purpose of the Study:

• To review current knowledge and identify gaps concerning antenatal corticosteroid use in preterm, late preterm, and term infants.
• To explore the application and evidence base for antenatal corticosteroids in special obstetric populations.
• To highlight areas requiring further research to optimize antenatal corticosteroid therapy.

Main Methods:

• Literature review of existing studies on antenatal corticosteroid use.
• Analysis of data concerning preterm, late preterm, and term populations.
• Examination of evidence in special populations including diabetes, multiple pregnancies, and periviable gestations.

Main Results:

• Established efficacy in reducing neonatal morbidity and mortality in preterm birth.
• Identified significant knowledge gaps in specific gestational age groups and special populations.
• Highlighted the need for more high-quality data, particularly from randomized controlled trials, in certain contexts.

Conclusions:

• Antenatal corticosteroids are vital but require further research to refine usage guidelines.
• Evidence is insufficient for definitive recommendations in complex cases like diabetes or multiple gestations.
• Addressing knowledge gaps is essential for improving neonatal outcomes in diverse obstetric scenarios.