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Technical Update No. 439: Antenatal Corticosteroids at Late Preterm Gestation
Jessica Liauw1, Hannah Foggin2, Peter Socha3
1Vancouver, BC.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|December 26, 2022
Summary
Antenatal corticosteroids given between 34 and 36 weeks gestation reduce respiratory distress but increase hypoglycemia in newborns. Long-term effects of this late preterm treatment remain uncertain, requiring careful consideration for pregnant individuals.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Evidence-Based Medicine
Background:
- Antenatal corticosteroids are crucial for fetal lung maturation.
- Recommendations for use in the late preterm period (34-36 weeks) require updated evidence.
- Balancing neonatal benefits against potential harms is essential.
Approach:
- Systematic review and meta-analysis of randomized controlled trials and observational studies.
- Inclusion of data from Cochrane reviews and recent literature searches (2020-2022).
- Utilized the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for evidence quality and recommendation strength.
Key Points:
- Antenatal corticosteroid administration in late preterm infants reduces neonatal respiratory distress.
- This intervention is associated with an increased risk of neonatal hypoglycemia.
- Long-term neurodevelopmental and other outcomes following late preterm corticosteroid exposure are not well-established.
Conclusions:
- Current evidence supports a trade-off between reduced respiratory morbidity and increased hypoglycemia with late preterm antenatal corticosteroid use.
- The uncertainty surrounding long-term impacts necessitates cautious application of this intervention.
- Further research is needed to clarify long-term sequelae and inform definitive guidelines.
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