Antenatal steroids: benefits, risks, and new insights

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Pharmacology

Background:

• Preterm birth before 37 weeks' gestation is a major cause of infant mortality and disability.
• Antenatal steroids (ANS) are administered to women at risk of preterm delivery to accelerate fetal lung maturation.
• Despite decades of use, significant uncertainties persist regarding optimal ANS protocols.

Purpose of the Study:

• To review existing data on antenatal steroid therapy for preterm birth.
• To provide an update on recent advancements in ANS treatment.
• To identify strategies for optimizing ANS efficacy and safety.

Main Methods:

• Comprehensive literature review of antenatal steroid therapy.
• Analysis of clinical data on ANS agents, dosing, and gestational age.
• Evaluation of benefits versus potential harms of ANS treatment.

Main Results:

• Antenatal steroids are effective in reducing mortality and morbidity associated with preterm birth.
• Current evidence highlights variability in optimal agent, dose, and gestational window for ANS.
• Expanding late-preterm administration shows modest benefits with unresolved safety concerns.

Conclusions:

• Optimizing antenatal steroid therapy is crucial for maximizing benefits and minimizing risks.
• Further research is needed to refine ANS protocols for diverse clinical scenarios.
• Standardizing ANS use requires addressing uncertainties in application and dosing.