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Antenatal Late Preterm Steroids: The Evolution of the ALPS Trial
1Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, La Jolla, California.
Insights
Antenatal corticosteroids given to mothers in late preterm labor significantly reduced respiratory issues in newborns. This landmark Antenatal Late Preterm Steroids (ALPS) trial findings altered clinical practice for late preterm infants.
Area of Science:
- Obstetrics and Neonatal Care
- Clinical Trial Design and Outcomes
- Respiratory Morbidity in Preterm Infants
Background:
- Late preterm infants (34-36 weeks gestation) face significant respiratory risks.
- Existing treatments for respiratory distress syndrome were suboptimal for this population.
- The Antenatal Late Preterm Steroids (ALPS) trial was initiated to address this gap.
Purpose of the Study:
- To evaluate the efficacy of antenatal corticosteroids in reducing respiratory morbidity in infants born late preterm.
- To provide evidence-based guidelines for managing pregnancies at risk of late preterm birth.
Main Methods:
- Detailed description of the Antenatal Late Preterm Steroids (ALPS) trial design.
- Inclusion/exclusion criteria for participants.
- Primary and secondary outcome measures for respiratory morbidity.
Main Results:
- Presentation of the primary findings regarding respiratory outcomes.
- Analysis of secondary outcomes, including neonatal intensive care unit admissions and length of stay.
- Discussion of the impact on clinical practice in the United States.
Conclusions:
- Antenatal corticosteroids are effective in mitigating respiratory morbidity in late preterm infants.
- The ALPS trial has fundamentally changed obstetric practice for late preterm births.
- Long-term follow-up data provides insights into the lasting effects of the intervention.
Abstract:
The Antenatal Late Preterm Steroids (ALPS) trial was designed to address respiratory morbidity common in infants born late preterm. The study was published in April, 2016 and, shortly thereafter, changed clinical practice in obstetrics in the United States. The following chapter describes the ALPS trial study design in detail, including the background leading to the trial, the study outcomes, and the initial findings of the long-term follow-up study. The ALPS story would not be complete without Elizabeth Thom, PhD, who died before her time. Her brilliance largely contributed to the design of the ALPS trial.
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