Controversies in antenatal corticosteroid treatment

Thevathasan, Iniyaval; Said, Joanne

doi:10.1002/pd.5664

Cited by 13 publications

(12 citation statements)

References 121 publications

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“…The use of dexamethasone and betamethasone (both fluorinated glucocorticoids) should be reserved for fetal lung maturity only 40. In such cases, on the day of administration, the corticosteroids used for maternal disease should be omitted.…”

Section: Managementmentioning

confidence: 99%

Diagnosis and management of covid-19 in pregnancy

Nana

Hodson

Lucas

et al. 2022

BMJ

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Pregnant women with covid-19 are at greater risk of severe disease than their non-pregnant peers, and yet they are frequently denied investigations or treatments because of unfounded concerns about risk to the fetus. The basic principles of diagnosing and managing covid-19 are the same as for non-pregnant patients, and a multidisciplinary, expert team approach is essential to ensure optimal care. During pregnancy, treatment with corticosteroids should be modified to use non-fluorinated glucocorticoids. Il-6 inhibitors and monoclonal antibodies, together with specific antiviral therapies, may also be considered. Prophylaxis against venous thromboembolism is important. Women may require respiratory support with oxygen, non-invasive ventilation, ventilation in a prone position (either awake or during invasive ventilation), intubation and ventilation, and extracorporeal membrane oxygenation (ECMO). Pregnancy is not a contraindication for any of these supportive therapies, and the criteria for providing them are the same as in the general population. Decisions regarding timing, place, and mode of delivery should be taken with a multidisciplinary team including obstetricians, physicians, anesthetists, and intensivists experienced in the care of covid-19 in pregnancy. Ideally these decisions should take place in consultation with centers that have experience and expertise in all these specialties.

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Section: Managementmentioning

confidence: 99%

Diagnosis and management of covid-19 in pregnancy

Nana

Hodson

Lucas

et al. 2022

BMJ

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“…10 Although this prophylactic treatment is recommended for potential premature births by the American College of Obstetricians and Gynecologists 11 and the Royal College of Obstetricians and Gynecologists, 12 there remains a controversy regarding multiple gestations. 13 14 While the efficacy of ACS treatment in singletons is supported by abundant evidence, the current evidence in multiple gestations is limited and less consistent. [15][16][17][18][19][20][21][22][23][24][25] Strengths and limitations of this study ► This is a meta-analysis investigating the benefits of antenatal corticosteroids (ACS) in preterm multiple gestations since this group is not addressed separately in previous systematic reviews.…”

Section: Introductionmentioning

confidence: 99%

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

et al. 2021

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ObjectiveThis meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies.MethodsThe PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies investigating the outcomes among preterm multiple gestations following to ACS, from their inception to 1 November 2020. Two authors independently performed the study selection, risk of bias assessment and data extraction. The primary outcomes were respiratory distress syndrome (RDS) and mortality and secondary outcomes included intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Pooled ORs were obtained using random effects models. Subgroup analyses were performed to explain heterogeneity by ACS completeness, administration-to-delivery intervals (≤7 days) and single or multicentre.ResultsA total of 16 observational studies with 36 973 newborns were included in the meta-analysis. ACS treatment was associated with a reduction in RDS (OR 0.66; 95% CI 0.54 to 0.82; I2=91.4%; p<0.001), mortality (OR 0.64; 95% CI 0.50 to 0.81; I2=85.9%; p<0.001), IVH (OR 0.67; 95% CI 0.54 to 0.83; I2=77.4%; p<0.001) and PVL (OR 0.65; 95% CI 0.47 to 0.92; I2=75.5%; p<0.001). Subgroup analyses showed ACS completeness, administration-to-delivery interval and multicentre study affected these associations.DiscussionACS may be beneficial for reducing the risks of RDS, mortality, IVH and PVL among preterm multiple gestations. The efficacy of ACS could be affected by ACS completeness and administration-to-delivery. More robust evidence on the efficacy of ACS treatment among multiple gestations is warranted.

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“…The advantage of lung maturation is balanced against the risks. These risks were shown in the ACTORDS trial which gave either betamethasone or placebo to women still at risk of pre-term birth prior to 32+0 weeks gestation after they had already received one course of corticosteroids 11 . This group reported growth retardation that was fully reversed by hospital discharge 12 .…”

Section: Antenatal Steroid Usementioning

confidence: 99%

Steroid use in Pregnancy with Severe COVID-19

Corp

Lawton

Young

et al. 2021

Preprint

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Managing women who are pregnant with severe COVID-19 is complex. This paper focuses on the debate surrounding steroid use in this group. Unfortunately, despite international efforts to identify treatments for COVID-19, there is very little research which has focussed specifically on pregnant women. Therefore current guidance is based on consensus and expert opinion, with variation in these guidelines worldwide, and reports that 73% of pregnant women do not receive steroids at all. There is an assumption of a steroid class-effect implicit within the UK guidelines for the mother with COVID-19 which is at odds with established within-class differences for effects on the foetus. This now warrants further discussion given the increasing numbers of pregnant women being admitted to hospital with COVID-19.

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Controversies in antenatal corticosteroid treatment

Cited by 13 publications

References 121 publications

Diagnosis and management of covid-19 in pregnancy

Diagnosis and management of covid-19 in pregnancy

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

Steroid use in Pregnancy with Severe COVID-19

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