Antenatal steroids

Abstract

Purpose of reviewThe beneficial effects of antenatal steroids in women at risk of preterm birth are evident. A dose of 24 mg appears sufficient, but there are insufficient data to recommend betamethasone or dexamethasone, a single steroid dose, the optimal interval between doses and repeated courses, the gestational age at which treatment is beneficial and the long-term effects of steroid treatment. This review addresses these aspects of antenatal steroid treatment.Recent findingsAlthough the 12-h and 24-h dosing intervals are equivalent with respect to prevention of respiratory distress syndrome, the former enables the completion of treatment in 50% more neonates delivered prematurely. Reducing the single steroid dose in patients at risk for premature birth reduces the associated maternal side effects. An inverse relationship has been demonstrated between the number of corticosteroid courses and foetal growth. The reduced size of exposed foetuses has been attributed to birth at earlier gestational ages and decreased foetal growth. Evidence suggests that antenatal exposure to synthetic glucocorticoids in term-born children has long-lasting effects, which may have important implications in the recommendation of steroids before elective caesarean at term.SummaryThe short-term and long-term effects of the dosage regimen on the pregnant mother and foetus remain unclear.

Glycemia after Betamethasone in Pregnant Women without Diabetes—Impact of Marginal Values in the 75-g OGTT

“…As expected, a change in the glycemic profile following BM was noted [7,8,12,15,17], with a large proportion of pregnant women (79.5%) requiring insulin administration for a short period of time. This was associated with the dosing of BM but not with other key parameters such as gestational age or weight gain in pregnancy.…”

“…Great attention is paid to the group of pregnant women who have either pre-existing diabetes or gestational diabetes, and especially those under insulin therapy. In this case, it is recommended, by limited bibliographic data, to up-titrate the insulin dose by 30%-40% in order to prevent very high blood glucose levels, which may exacerbate an already at-risk pregnancy (hydramnios) [7][8][9][10][11][12][13][14][15][16]. Furthermore, hyperglycemia can lead to severe neonatal hypoglycemia in the case of preterm delivery [7,9,12].…”

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

“…Exogenous glucocorticoids are administered to pregnant women at imminent risk of preterm birth to mature the fetal lungs, and preterm birth is a common complication of FGR. Preclinical and clinical evidence demonstrates that antenatal steroids may exacerbate growth restriction (particularly repeat doses) (18) and that the FGR fetus differentially responds to antenatal steroids compared to appropriately-grown fetuses, likely mediated via altered placental response to steroids (19). Antenatal glucocorticoids may not significantly improve neonatal outcomes in FGR preterm infants (20), and indeed, may have adverse effects on brain development (21, 22).…”

Does the corticosteroid’s treatment during the pre and postnatal period affect the neurodevelopmental outcome of premature newborns?

“…A pesar de ello, algunos autores opinan que no existe suficiente evidencia para recomendar el uso de una o dos dosis de betametasona o dexametasona, o de un esquema único o múltiple. Además, tampoco existe certeza sobre el intervalo óptimo entre las dosis y se desconocen los efectos adversos que el tratamiento pueda tener a largo plazo en el neonato (14).…”