[Benefits and risks of antenatal corticosteroids]

Area of Science:

• Obstetrics and Gynecology
• Neonatology
• Pediatric Neurology

Background:

• Antenatal corticosteroids are crucial for preterm birth management.
• A single course before 34 weeks improves neonatal outcomes but carries potential long-term risks.
• Repeated courses show neonatal benefits but raise concerns about birth weight and neurological development.

Purpose of the Study:

• To evaluate the benefit-risk ratio of antenatal corticosteroid administration for preterm delivery.
• To explore strategies for optimizing antenatal corticosteroid therapy, including dose reduction and timing.
• To provide evidence-based recommendations for clinical practice.

Main Methods:

• Review of existing literature and clinical trial data on antenatal corticosteroid use.
• Analysis of neonatal and childhood outcomes associated with single vs. repeated courses.
• Examination of dose-reduction strategies and potential timing improvements.

Main Results:

• A single course before 34 weeks significantly reduces respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and mortality.
• Potential long-term risks include adult insulin resistance and childhood behavioral issues.
• Repeated courses are not recommended due to risks of decreased birth weight and neurological impairment.
• A French trial suggested similar survival without severe morbidity with half-dose vs. full-dose, but further data is needed.

Conclusions:

• Antenatal corticosteroids are recommended for women at risk of preterm delivery before 34 weeks.
• Optimizing the benefit-risk ratio through dose or timing adjustments requires further investigation.
• Current evidence supports a single course, with ongoing research into refined administration strategies.