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Addressing the long-term risks of administering antenatal steroids
Sean W D Carter1,2, Agnihotri Biswas3, Hannah R S Watson2,4
1Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Expert Opinion on Pharmacotherapy
|March 4, 2025
Summary
Antenatal steroid (ANS) therapy reduces preterm birth complications but may pose long-term risks. Careful dosing and patient selection are crucial, especially in later gestations where benefits are less clear.
Area of Science:
- Perinatology
- Neonatology
- Developmental Toxicology
Background:
- Antenatal steroid (ANS) therapy is a standard intervention for women at risk of preterm birth.
- ANS therapy significantly reduces neonatal respiratory distress syndrome, morbidity, and mortality.
- Potential long-term adverse effects of ANS therapy remain an area of concern.
Purpose of the Study:
- To review glucocorticoid signaling, pharmacokinetics, pharmacodynamics, and clinical use of ANS.
- To assess the potential long-term harms associated with ANS therapy.
- To provide an expert opinion on the risk-benefit balance of ANS therapy.
Main Methods:
- Review of key concepts in glucocorticoid signaling and pharmacokinetics/pharmacodynamics.
- Analysis of clinical data regarding the long-term effects of ANS therapy.
- Expert assessment of current ANS therapy guidelines and practices.
Main Results:
- High-dose ANS regimens can induce fetal multi-system changes affecting growth and development.
- Long-term risks appear to correlate with the dose and duration of steroid exposure.
- Single-course ANS therapy between 24-34 weeks gestation is generally justified.
Conclusions:
- Optimizing ANS dosing and patient selection is essential.
- At periviable gestations, immediate survival benefits outweigh modest long-term risks.
- Routine ANS use in late preterm and term gestations requires further evaluation due to limited benefits.
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