Use of antenatal corticosteroids in special circumstances: a comprehensive review

Abstract

The aim of this study was to determine, in pregnancies complicated by preterm premature rupture of membranes (PPROM), hypertension, intrauterine growth restriction, multi-fetal gestations and pregnancies 23-26 weeks and ≥34 weeks' gestation, whether antenatal corticosteroids benefit the fetus. Literature review using PubMed, Web of Science, Clinical trials.gov, Cochrane Database of Systematic Reviews (1990Reviews ( -2015. Search terms linked special circumstances with corticosteroids. Randomized clinical trials, retrospective and prospective cohort studies, and case control studies were reviewed. In all, 468 abstracts were identified and 84 added from selected article bibliographies; of these, 503 abstracts were excluded, leaving 49 articles as the basis of review. The literature supports corticosteroids for PPROM up to 32-34 weeks without chorioamnionitis. Antenatal corticosteroids are beneficial for preterm infants of women with HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome/severe preeclampsia. Postpartum corticosteroid treatment of HELLP patients results in more rapid correction of liver enzymes, platelet counts, and urinary output, which can reduce maternal morbidity. Corticosteroids in twin pregnancies decrease respiratory distress syndrome but the effect is less than in singleton pregnancies. Corticosteroid effects on intrauterine growth restriction pregnancies are conflicting and steroid use should be individualized. Corticosteroid use for 23-26 weeks reduces neonatal mortality but not morbidity.

Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation

“…No difference was observed between steroid and control groups concerning the risk for necrotising enterocolitis, neonatal sepsis and Apgar score of less than 7 at 5 minutes. Perinatal mortality was similar between steroid and control groups . A meta‐analysis of observational studies suggest no increased risk of chorioamnionitis or neonatal sepsis with maternal steroid use …”

“…Perinatal mortality was similar between steroid and control groups. 20 A meta-analysis of observational studies suggest no increased risk of chorioamnionitis or neonatal sepsis with maternal steroid use. 21 Evidence level 1++ NG25 5 addresses the administration of corticosteroids to women with PPROM from 24 +0 until 35 +6 weeks of gestation, recommending that when offering or considering corticosteroids a discussion should take place with the woman about how steroids may help and the potential risks associated with their administration.…”

Good clinical practice advice: Antenatal corticosteroids for fetal lung maturation

“…If a single course of steroid treatment is used, the small decrement in birth weight noted after multiple courses of treatment in such patients appears to be negated. The benefit of maternal steroids in fetal growth‐restricted fetus’ outweighs the possible adverse effects . A randomized controlled trial is merited to clarify whether treatment brings any added benefit in growth‐restricted infants.…”

“…The benefit of maternal steroids in fetal growth-restricted fetus' outweighs the possible adverse effects. 13 A randomized controlled trial is merited to clarify whether treatment brings any added benefit in growthrestricted infants.…”

Letter to the Editor: Antenatal steroids and their administration time for preventing morbidity in preterm labor

“…While this group decreases the mortality rates in newborns, it does not affect morbidity rates. [5] Chorioamnionitis and multiple pregnancies are not contraindicated for the use of antenatal steroid, and its administration scheme is similar to singleton pregnancies. While the administration threshold for antenatal steroids was 34 weeks of gestation until two years ago, it was shown in a randomized controlled study which was supported NIH that extending administration time up to 37 weeks of gestation led to a decrease in newborn respiratory distress.…”