Effects of Antenatal Corticosteroids Given Prior to 26 Weeks' Gestation: A Systematic Review of Randomized Controlled Trials

Abstract

Although it is generally accepted that antenatal corticosteroids reduce neonatal complications after preterm labor, it is unclear at what gestational age this effect starts to occur. We conducted a systematic review of the literature to determine the effects of antenatal corticosteroids given to women at risk of preterm birth <26 weeks' gestation. Two reviewers independently searched electronic databases and the Cochrane Library for randomized controlled trials including women at imminent birth at a gestational age <26 weeks. Nine randomized trials were included. Meta-analyses and meta-regression of trials including participants with a lower gestational age revealed no significant reduction of neonatal mortality and morbidity in the corticosteroid group as compared with nonintervention, in contrast to clear evidence of beneficial effects in trials including women given corticosteroids at a later gestational age. A gestational age-dependent effect of antenatal corticosteroids on neonatal outcomes with lesser treatment benefits in patients <26 weeks' gestational age appears to exist. There is no evidence from randomized controlled trials to support or refute the recommendation of administrating antenatal corticosteroids to women at risk of preterm birth <26 weeks' gestation.

Pulmonary Effects of Prolonged Oligohydramnios following Mid-Trimester Rupture of the Membranes – Antenatal and Postnatal Management

“…Antenatal corticosteroids should be given to women presenting with PPROM prior to 32 weeks as they reduce the incidence of neonatal death, respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis and the duration of respiratory support, without increasing maternal or neonatal infection [40] , although the evidence for a beneficial effect below 26 weeks' gestational age is less clear [41] .…”

Changes in the outcome of extremely low birth weight infants less than 500 grams in the First Department of Obstetrics and Gynecology, Semmelweis University

“…A 24. gesztációs hét előtti fenyegető koraszülés eseteire is javasolt a betamethason vagy dexamethason adása. A szteroidprofi laxis nemcsak a túl-élési esélyt javítja szignifi kánsan, hanem a szövődmények (BPD, IVH, PVL, ROP, NEC) előfordulási gyakoriságát is csökkenti [5,8,9,10].…”

Morbimortalidad de recién nacidos con menos de 1500 gramos asistidos en hospitales públicos de la Ciudad de Buenos Aires

“…Está ampliamente demostrado que su empleo antenatal disminuye el riesgo de SDR y el uso de recursos. 13,14 Sin embargo, en nuestra población, el porcentaje que recibió una serie completa de corticoides se mantuvo en el 40,4%, muy por debajo de otras redes. 15,16 Esta diferencia puede explicarse por subregistro.…”