Antenatal corticosteroids: an assessment of anticipated benefits and potential risks

Jobe, Alan H.; Goldenberg, Robert L.

doi:10.1016/j.ajog.2018.04.007

Cited by 124 publications

(108 citation statements)

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“…Administration of antenatal glucocorticoids is an important part of patient management of pregnancies at risk of preterm birth to promote the maturation of the fetal lung (Schellhase and Shannon, 1991;Jobe and Goldenberg, 2018). In addition to corticosteroids, intrauterine inflammation affects the developing lung potentially through an independent pathway (Moss and Westover, 2017).…”

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confidence: 99%

Endothelial Sash1 Is Required for Lung Maturation through Nitric Oxide Signaling

et al. 2019

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Section: Introductionmentioning

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Endothelial Sash1 Is Required for Lung Maturation through Nitric Oxide Signaling

et al. 2019

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“…use in the United States. Drug coverage is as high as 90% of women at risk of preterm delivery in high resource environments . However, due in part to unproven efficacy and poor drug availability, drug coverage is very low in many low resource environments with limited maternal and newborn care …”

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“…Dose‐ranging trials were never performed to evaluate efficacy or safety because the indication is off label and the drugs are readily available and inexpensive . However, these potent corticosteroids have significant complications associated with routine short‐term use .…”

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confidence: 99%

“…Drug coverage is as high as 90% of women at risk of preterm delivery in high resource environments. 5 However, due in part to unproven efficacy and poor drug availability, drug coverage is very low in many low resource environments with limited maternal and newborn care. 6 Dose-ranging trials were never performed to evaluate efficacy or safety because the indication is off label and the drugs are readily available and inexpensive.…”

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confidence: 99%

“…6 Dose-ranging trials were never performed to evaluate efficacy or safety because the indication is off label and the drugs are readily available and inexpensive. 4,5 However, these potent corticosteroids have significant complications associated with routine short-term use. 7 Dosing for ACS is indirect because the pregnant woman is given the phosphorylated or acetylated prodrugs to achieve a benefit for the premature newborn with the time from treatment to preterm delivery often predicted poorly.…”

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Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Jobe

Milad²,

Peppard

et al. 2019

Clinical Translational Sci

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High‐dose betamethasone and dexamethasone are standard of care treatments for women at risk of preterm delivery to improve neonatal respiratory and mortality outcomes. The dose in current use has never been evaluated to minimize exposures while assuring efficacy. We report the pharmacokinetics and pharmacodynamics (PDs) of oral and intramuscular treatments with single 6 mg doses of dexamethasone phosphate, betamethasone phosphate, or a 1:1 mixture of betamethasone phosphate and betamethasone acetate in reproductive age South Asian women. Intramuscular or oral betamethasone has a terminal half‐life of 11 hours, about twice as long as the 5.5 hours for oral and intramuscular dexamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate shows an immediate release of betamethasone followed by a slow release where plasma betamethasone can be measured out to 14 days after the single dose administration, likely from a depo formed at the injection site by the acetate. PD responses were: increased glucose, suppressed cortisol, increased neutrophils, and suppressed basophils, CD3CD4 and CD3CD8 lymphocytes. PD responses were comparable for betamethasone and dexamethasone, but with longer times to return to baseline for betamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate caused much longer adrenal suppression because of the slow release. These results will guide the development of better treatment strategies to minimize fetal and maternal drug exposures for women at risk of preterm delivery.

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Antenatal Corticosteroids—Too Much of a Good Thing?

DeMauro

2020

JAMA

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Antenatal corticosteroids: an assessment of anticipated benefits and potential risks

Cited by 124 publications

References 105 publications

Endothelial Sash1 Is Required for Lung Maturation through Nitric Oxide Signaling

Endothelial Sash1 Is Required for Lung Maturation through Nitric Oxide Signaling

Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Antenatal Corticosteroids—Too Much of a Good Thing?

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