Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes

Sotiriadis, Alexandros; McGoldrick, Emma; Makrydimas, George; Papatheodorou, Stefania; Ioannidis, John P. A.; Stewart, Fiona; Parker, Roses

doi:10.1002/14651858.cd006614.pub4

Cited by 17 publications

(23 citation statements)

References 62 publications

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“…7 Moreover, the benefits of ACT administered at term before an elective cesarean delivery are questionable and based on evidence judged as low or very low in certainty, with only 1 RCT suggesting, with a moderate degree of certainty, that ACT probably decreases the risk of admission to the NICU for respiratory complications. 8 Our findings challenge the Cochrane meta-analysis, 1 including 3 RCTs with neurodevelopmental delay as an outcome. These RCTs included a total of 600 children aged 2 to 12 years, born preterm in the 1980s or 1990s, and suggested with a moderate degree of certainty that ACT was associated with a reduced risk of neurodevelopmental delay.…”

Section: Jama Network Open | Obstetrics and Gynecologymentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

“… 8 Antenatal corticosteroid treatment is not associated with mortality in either situation. 5 , 6 , 7 , 8 The US guidelines recommend consideration of ACT in these situations, 2 while a similar recommendation was removed from the 2019 update of the European guideline. 3 The 2021 guideline by the International Federation of Gynaecology and Obstetrics specifically advises against routine use of ACT after 34 weeks and 0 days of gestation.…”

Section: Introductionmentioning

confidence: 97%

“…In the former situation, ACT prevents respiratory morbidity, although this evidence has been recently challenged . In the latter situation, ACT reduces the risk of admission to the neonatal intensive care unit (NICU) for respiratory complications . Antenatal corticosteroid treatment is not associated with mortality in either situation .…”

Section: Introductionmentioning

confidence: 99%

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Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

et al. 2022

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IMPORTANCE Corticosteroids administered to women at risk of imminent preterm birth is one of the most effective ways to improve the prognosis of infants born preterm. Scant data about longterm neurodevelopmental and neurosensory outcomes among the treatment-exposed children are mixed, suggesting that not all domains of neurodevelopmental and neurosensory function may be equally affected. Moreover, the long-term outcomes may vary according to whether the treatmentexposed children are being born preterm (<37 weeks and 0 days) or term (Ն37 weeks and 0 days).OBJECTIVES To study whether antenatal corticosteroid treatment is associated with psychological developmental and neurosensory disorders in children born term and preterm and whether the associations persist in a sibling-comparison design.

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Section: Jama Network Open | Obstetrics and Gynecologymentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

et al. 2022

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“…The practice of ACS administration at late preterm and term gestations remains controversial in view of its association with neonatal hypoglycaemia [ 46 ], and the paucity of data on its effects on childhood and adult outcomes [ 47 ]; indeed, guidelines on the administration of ACS beyond 34 weeks gestation vary across countries contributing to the Co-OPT ACS cohort, and over time, as shown in S2 Table . However, our findings indicate this has become common clinical practice in Scotland: almost half of ACS-exposed babies born in Aberdeen (46.8%, n = 1320) received ACS from 34 weeks onwards.…”

Section: Discussionmentioning

confidence: 99%

Consortium for the Study of Pregnancy Treatments (Co-OPT): An international birth cohort to study the effects of antenatal corticosteroids

et al. 2023

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Background Antenatal corticosteroids (ACS) are widely prescribed to improve outcomes following preterm birth. Significant knowledge gaps surround their safety, long-term effects, optimal timing and dosage. Almost half of women given ACS give birth outside the “therapeutic window” and have not delivered over 7 days later. Overtreatment with ACS is a concern, as evidence accumulates of risks of unnecessary ACS exposure. Methods The Consortium for the Study of Pregnancy Treatments (Co-OPT) was established to address research questions surrounding safety of medications in pregnancy. We created an international birth cohort containing information on ACS exposure and pregnancy and neonatal outcomes by combining data from four national/provincial birth registers and one hospital database, and follow-up through linked population-level data from death registers and electronic health records. Results and discussion The Co-OPT ACS cohort contains 2.28 million pregnancies and babies, born in Finland, Iceland, Israel, Canada and Scotland, between 1990 and 2019. Births from 22 to 45 weeks’ gestation were included; 92.9% were at term (≥ 37 completed weeks). 3.6% of babies were exposed to ACS (67.0% and 77.9% of singleton and multiple births before 34 weeks, respectively). Rates of ACS exposure increased across the study period. Of all ACS-exposed babies, 26.8% were born at term. Longitudinal childhood data were available for 1.64 million live births. Follow-up includes diagnoses of a range of physical and mental disorders from the Finnish Hospital Register, diagnoses of mental, behavioural, and neurodevelopmental disorders from the Icelandic Patient Registers, and preschool reviews from the Scottish Child Health Surveillance Programme. The Co-OPT ACS cohort is the largest international birth cohort to date with data on ACS exposure and maternal, perinatal and childhood outcomes. Its large scale will enable assessment of important rare outcomes such as perinatal mortality, and comprehensive evaluation of the short- and long-term safety and efficacy of ACS.

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Do antenatal corticosteroids help prevent neonatal respiratory morbidity after elective cesarean section at term?

Burch¹,

Martin²

2018

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Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes

Cited by 17 publications

References 62 publications

Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

Consortium for the Study of Pregnancy Treatments (Co-OPT): An international birth cohort to study the effects of antenatal corticosteroids

Do antenatal corticosteroids help prevent neonatal respiratory morbidity after elective cesarean section at term?

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