Maternal corticosteroid use: effects on the fetus and neonate

Abstract

Preterm birth is a leading cause of perinatal mortality and morbidity and continues to be one of the most common complications plaguing obstetrics and neonatology. Primary prevention of preterm birth remains the ultimate but elusive goal. However, efforts to curtail the impact of preterm birth are of great importance. Use of antenatal corticosteroids (ACSs) in threatened preterm labor has been one of the landmark interventions that have improved the neonatal outcome. Since the start of use of ACS: the acceptance has increased dramatically and now it has become the standard of care in threatened preterm labor. However, there are still many unresolved issues surrounding the usage of ACS. In this article, we attempt to synthesize the current available evidence and its application in our daily clinical scenarios.

Keywords::

• corticosteroids
• neonatal mortality
• neurodevelopmental outcomes
• prematurity
• respiratory distress syndrome

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Antenatal corticosteroid (ACS) use has been shown to reduce the risk of neonatal mortality, respiratory distress syndrome, intra-ventricular hemorrhage and necrotizing enterocolitis. It also significantly decreases the need for respiratory support and admission to neonatal intensive care unit.

• • The benefit of ACS is seen across a wide range of gestational ages from 24 to 34 + 6 weeks. Further clarification is needed on the role of ACS in late preterm infants and after elective caesarean sections in term infants.

• • The beneficial effect of ACS is seen in the subgroups of women with premature rupture of membranes and those with hypertension syndromes.

• • All pregnant women with threatened preterm delivery should receive single course of ACS. Multiple courses of ACS are not recommended on routine basis.