Are we prescribing multiple courses of antenatal corticosteroids? A survey of practice in the UK

Abstract

A postal questionnaire concerned with prescribing antenatal corticosteroids was sent to one named clinician at each of 279 obstetric units in the UK. They were asked whether their unit prescribed repeated courses, the indications for which these would be prescribed, the interval between courses, the drugs and regimens used and whether they would be willing to participate in a proposed randomised controlled trial. The response rate was 75%. Of the respondents, 98% prescribed repeated courses; the indications most commonly cited by units who prescribed steroids were prelabour spontaneous rupture of membranes (84.2%) and suspected preterm labour (81.8%). 70.6% of units were willing to participate in the proposed trial.

Repeated Antenatal Glucocorticoid Exposure and the Developing Brain: Commentary on the article by Modi et al. on page 581

“…Indeed, an Australian survey identified 97% of obstetricians prescribing antenatal glucocorticoids while 85% prescribed repeated courses (2). Similar results were recently reported for a survey of British obstetricians, where some centers may prescribe up to 11 repeat courses (3). Although a single course of glucocorticoid treatment is highly effective in preventing pulmonary complications, there is no conclusive evidence as to whether repeated GC therapy provides any further benefit.…”

Uso indicado e uso referido de medicamentos durante a gravidez

“…O corticóide antenatal é intervenção comprovadamente eficaz para diminuição da morbidade associada à prematuridade 28,29 . Observa-se, no entanto, que a prevalência de indicação está bastante distante da dos países mais desenvolvidos, quando essa taxa oscila entre 30% e 98% 30 , em vigência do risco.…”

Repeated maternal glucocorticoid treatment affects activity and hippocampal NMDA receptor expression in juvenile guinea pigs

“…The majority of these women are prescribed antenatal glucocorticoid therapy in order to develop the fetal lungs. Indeed, surveys of obstetrical practice indicate that, until recently, repeated dose regimens have been common (Quinlivan et al 1998;Brocklehurst et al 1999). However, the long-term behavioural consequences of repeated prenatal glucocorticoid exposure on behaviour are largely unknown.…”