Antenatal steroids for fetal lung maturity: Time to target more frequent doses to fewer women?
- 21 September 2015
- journal article
- review article
- Published by SAGE Publications in Obstetric Medicine
- Vol. 8 (4), 172-176
- https://doi.org/10.1177/1753495x15601772
Abstract
Antenatal corticosteroids for fetal lung maturation have become mainstay treatment in women thought to be at high-risk of premature birth. To ensure treatment efficacy before delivery, the current practice is to administer steroids early to a woman considered at risk; however, neonatal benefit is lost after the seven-day treatment-to-delivery window. Over half of women who deliver before 34 weeks’ gestation do not receive antenatal corticosteroids within this timeframe, but many still deliver prematurely; however, clinicians are reluctant to administer repeated courses of steroids due to concerns, among others, of impaired fetal growth. However, evidence is mounting regarding the optimal timing for steroids, including substantive benefits close to delivery, and the benefits of repeated courses if delivery has not occurred. Better targeted treatment is required to allow for maximum benefit; reducing unnecessary treatment in low-risk women, while targeting therapy in the high-risk cohort and offering repeat courses if the seven-day window is exceeded. Novel tools to aid prediction may help implement this strategy.This publication has 25 references indexed in Scilit:
- Diagnostic accuracy of rapid phIGFBP-I assay for predicting preterm labor in symptomatic patientsJournal of Perinatology, 2011
- The value of combined cervical length measurement and fetal fibronectin testing to predict spontaneous preterm birth in asymptomatic high-risk womenThe Journal of Maternal-Fetal & Neonatal Medicine, 2010
- Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta‐analysisUltrasound in Obstetrics & Gynecology, 2009
- Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at termEmergencias, 2009
- Single versus weekly courses of antenatal corticosteroids: Evaluation of safety and efficacyAmerican Journal of Obstetrics and Gynecology, 2006
- Sonographic cervical length in singleton pregnancies with intact membranes presenting with threatened preterm laborUltrasound in Obstetrics & Gynecology, 2004
- Committee opnion: antenatal corticosteroid therapy for fetal maturationObstetrics & Gynecology, 2002
- Fetal fibronectin improves the accuracy of diagnosis of preterm laborAmerican Journal of Obstetrics and Gynecology, 1995
- The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trialsBJOG: An International Journal of Obstetrics and Gynaecology, 1990
- PREMATURE DELIVERY OF FOETAL LAMBS INFUSED WITH GLUCOCORTICOIDSJournal of Endocrinology, 1969