Optimizing antenatal corticosteroid therapy: Balancing benefit and risk in the era of precision medicine

Area of Science:

• Perinatal Medicine
• Neonatal Care
• Pharmacology

Background:

• Antenatal corticosteroid (ACS) therapy is crucial for reducing neonatal morbidity and mortality in preterm births.
• Current ACS use is expanding, necessitating a refined approach for diverse patient populations.
• Limited evidence exists for specific subpopulations like those with multiple pregnancies or chorioamnionitis.

Purpose of the Study:

• To synthesize current evidence on ACS pharmacokinetics, efficacy, and safety.
• To focus on dose optimization, long-term outcomes, and fetal treatment response variability.
• To explore tools for assessing fetal lung maturation and guiding individualized ACS therapy.

Main Methods:

• Comprehensive review of existing scientific literature on antenatal corticosteroid therapy.
• Analysis of data concerning pharmacokinetics, clinical efficacy, and safety profiles.
• Examination of studies on dose optimization, long-term sequelae, and predictive tools for fetal response.

Main Results:

• ACS therapy is effective but requires refined application in expanded eligible populations.
• Knowledge gaps exist regarding long-term neurodevelopmental outcomes and optimal dosing.
• Concerns regarding overexposure and non-pulmonary effects warrant further investigation.

Conclusions:

• Precision-based approaches are essential for optimizing ACS therapy benefits and minimizing harm.
• Development of tools for individualized risk prediction and treatment guidance is needed.
• Further research should address long-term neurodevelopmental outcomes and precise dosing strategies.