Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-28T12:28:43.167Z Has data issue: false hasContentIssue false

REPEAT ANTENATAL CORTICOSTEROIDS: SHOULD IT BE PRESCRIBED AND IF SO WHEN AND HOW?

Published online by Cambridge University Press:  01 May 2008

TAK YEUNG LEUNG*
Affiliation:
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, Hong Kong, China.
DALJIT SINGH SAHOTA
Affiliation:
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, Hong Kong, China.
*
Dr. TY Leung, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, Hong Kong, ChinaSAR

Extract

Corticosteroid treatment before preterm delivery was shown to be effective in reducing neonatal respiratory distress syndrome (RDS) more than three decades ago. The beneficial effect of steroids was further confirmed by Roberts and Dalziel's meta-analysis of 21 randomised controlled studies (RCT), which was published as a Cochrane Review in 2006. The authors concluded that the administration of a single course of steroids improved neonatal outcome, reducing RDS by 60%, periventricular haemorrhage (PVH) and necrotizing enterocolitis (NEC) by half, and neonatal death (NND) by 70%. However, these beneficial effects do not last for more than 7 days. Furthermore, steroids take at least 24 hours to be fully effective. Hence, it was advocated in the 1990's that regular weekly booster courses be given in order to maintain the therapeutic effects in high risk cases, as the timing of preterm birth cannot be readily predicted.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1Liggins, GC, Howie, RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50: 515–25.CrossRefGoogle ScholarPubMed
2Roberts, D, Dalziel, S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; 3: CD004454.Google Scholar
3Brocklehurst, P, Gates, S, McKenzie-McHarg, K, Alfirevic, Z, Chamberlain, G. Are we prescribing multiple courses of antenatal corticosteroids? A survey of practice in the UK. Br J Obstet Gynaecol 1999; 106: 977–79.CrossRefGoogle ScholarPubMed
4Quinlivan, JA, Evans, SF, Dunlop, SA, Beazley, LD, Newnham, JP. Use of corticosteroids by Australian obstetricians–a survey of clinical practice. Aust N Z J Obstet Gynaecol 1998; 38: 17.CrossRefGoogle ScholarPubMed
5Newnham, JP, Moss, TJ. Antenatal glucocorticoids and growth: single versus multiple doses in animal and human studies. Semin Neonatol 2001; 6: 285–92.CrossRefGoogle ScholarPubMed
6French, NP, Hagan, R, Evans, SF, Mullan, A, Newnham, JP. Repeated antenatal corticosteroids: effects on cerebral palsy and childhood behavior. Am J Obstet Gynecol 2004; 190: 588–95.CrossRefGoogle ScholarPubMed
7Aghajafari, F, Murphy, K, Matthews, S, Ohlsson, A, Amankwah, K, Hannah, M. Repeated doses of antenatal corticosteroids in animals: a systematic review. Am J Obstet Gynecol 2002; 186: 843–49.CrossRefGoogle ScholarPubMed
8Crowther, CA, Harding, JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease. Cochrane Database Syst Rev 2007; 3: CD003935.Google Scholar
9Guinn, DA, Atkinson, MW, Sullivan, L, Lee, M, MacGregor, S, Parilla, BV et al. Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery: A randomized controlled trial. JAMA 2001; 286: 1581CrossRefGoogle ScholarPubMed
10Aghajafari, F, Murphy, K, Ohlsson, A, Amankwah, K, Matthews, S, Hannah, ME. Multiple versus single courses of antenatal corticosteroids for preterm birth: a pilot study. J Obstet Gynaecol Can 2002; 24: 321–29.CrossRefGoogle ScholarPubMed
11McEvoy, C, Bowling, S, Williamson, K, Lozano, D, Tolaymat, L, Izquierdo, L et al. The effect of a single remote course versus weekly courses of antenatal corticosteroids on functional residual capacity in preterm infants: a randomized trial. Pediatrics 2002; 110: 280–84.CrossRefGoogle ScholarPubMed
12Wapner, RJ, Sorokin, Y, Thom, EA, Johnson, F, Dudley, DJ, Spong, CY et al. National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol 2006; 195: 633–42.CrossRefGoogle ScholarPubMed
13Crowther, CA, Haslam, RR, Hiller, JE, Doyle, LW, Robinson, JS. Australasian Collaborative Trial of Repeat Doses of Steroids (ACTORDS) Study Group. Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomised controlled trial. Lancet 2006; 367: 1913–919.CrossRefGoogle Scholar
14Crowther, CA, Doyle, LW, Haslam, RR, Hiller, JE, Harding, JE, Robinson, JS. ACTORDS Study Group. Outcomes at 2 years of age after repeat doses of antenatal corticosteroids. N Engl J Med 2007; 357: 1179–189.CrossRefGoogle ScholarPubMed
15Wapner, RJ, Sorokin, Y, Mele, L, Johnson, F, Dudley, DJ, Spong, CY et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Long-term outcomes after repeat doses of antenatal corticosteroids. N Engl J Med 2007; 357: 1190–198.CrossRefGoogle ScholarPubMed
16Haung, WL, Beazley, LD, Quinlivan, JA, Evans, SF, Newnham, JP, Dunlop, SA. Effects of corticosteroids on brain growth in fetal sheep. Obstet Gynecol 1999; 94: 213–18.Google Scholar
17Dunlop, SA, Archer, MA, Quinlivan, JA, Beazley, LD, Newnham, JP. Multiple prenatal corticosteroids delay myelination in the ovine central nervous system. J Matern Fetal Med 1997; 6: 309–13.Google Scholar
18Quinlivan, JA, Dunlop, SA, Newnham, JP, Evans, SF, Beazley, LD. Repeated, but not single, maternal administration of corticosteroids delays myelination in the brain of fetal sheep. Prenat Neonat Med 1999; 4: 4755.Google Scholar
19Quinlivan, JA, Beazley, LD, Evans, SF, Newnham, JP, Dunlop, SA. Retinal maturation is delayed by repeated, but not single, maternal injections of betamethasone in sheep. Eye 2000; 14: 9398.CrossRefGoogle Scholar
20Uno, H, Lohmiller, L, Thieme, C, Kemnitz, JW, Engle, MJ, Rocker, EB et al. Brain damage induced by prenatal exposure to dexamethasone in fetal rhesus macaques, I: hippocampus. Dev Brain Res 1990; 53: 157–67.CrossRefGoogle ScholarPubMed
21Owen, D, Matthew, SG. Repeated maternal glucocorticoid treatment affects activity and hippocampal NMDA receptor expression in juvenile guinea pigs. J Physiol 2007; 578: 249–57.CrossRefGoogle ScholarPubMed
22French, NP, Hagan, R, Evans, SF, Mullan, A, Newnham, JP. Repeated antenatal corticosteroids: effects on cerebral palsy and childhood behaviour. Am J Obstet Gynecol 2004; 190: 588–95.CrossRefGoogle Scholar
23Spinillo, A, Viazzo, E, Colleoni, R, Chiara, A, Maria Cerbo, R, Fazzi, E. Two-year infant neurodevelopmental outcome after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity. Am J Obstet Gynecol 2004; 191: 217–24.CrossRefGoogle ScholarPubMed
24French, NP, Hagan, R, Evans, SF, Godfrey, M, Newnham, JP. Repeated antenatal corticosteroids: size at birth and subsequent development. Am J Obstet Gynecol 1999; 180: 114–21.CrossRefGoogle ScholarPubMed
25Hasbargen, U, Reber, D, Versmold, H, Schulze, A. Growth and development of children to 4 years of age after repeated antenatal steroid administration. Eur J Pediatr 2001; 160: 552–55.CrossRefGoogle ScholarPubMed
26Anday, EK, Conway, D. Steroid therapy in the high-risk neonate: benefits and risks. Clin Obstet Gynecol 2003; 46: 190210.CrossRefGoogle ScholarPubMed
27Watterberg, KL, Scott, SM, Backstrom, C, Gifford, KL, Cook, KL. Links between early adrenal function and respiratory outcome in preterm infants: airway inflammation and patent ductus arteriosus. Pediatrics 2000; 105: 320–24.CrossRefGoogle ScholarPubMed
28Ashwood, PJ, Crowther, CA, Willson, KJ, Haslam, RR, Kennaway, DJ, Hiller, JE et al. Neonatal adrenal function after repeat dose prenatal corticosteroids: a randomized controlled trial. Am J Obstet Gynecol 2006; 194: 861–67CrossRefGoogle ScholarPubMed
29Battin, MR, Bevan, C, Harding, JE. Repeat doses of antenatal steroids and hypothalamic-pituitary-adrenal axis (HPA) function. Am J Obstet Gynecol 2007; 197: 40. E16.CrossRefGoogle ScholarPubMed
30Moss, TJ, Harding, R, Newnham, JP. Lung function, arterial pressure and growth in sheep during early postnatal life following single and repeated prenatal corticosteroid treatments. Early Hum Dev 2002; 66: 1124.CrossRefGoogle ScholarPubMed
31Dalziel, SR, Parag, V, Rodgers, A, Harding, JE. Cardiovascular risk factors at age 30 following pre-term birth. Int J Epidemiol 2007; 36: 907–15.CrossRefGoogle ScholarPubMed
32Leon, DA, Johansson, M, Rasmussen, F. Gestational age and growth rate of fetal mass are inversely associated with systolic blood pressure in young adults: an epidemiologic study of 165,136 Swedish menaged 18 years. Am J Epidemiol 2000; 152: 597604.CrossRefGoogle Scholar
33Dalziel, SR, Walker, NK, Parag, V, Mantell, C, Rea, HH, Rodgers, A, Harding, JE. Cardiovascular risk factors after antenatal exposure to betamethasone: 30-year follow-up of a randomised controlled trial. Lancet 2005; 365: 1856–62.CrossRefGoogle ScholarPubMed
34Dessens, AB, Haas, HS, Koppe, JG. Twenty-year follow-up of antenatal corticosteroid treatment. Pediatrics 2000; 105: E77.CrossRefGoogle ScholarPubMed
35Anotayanonth, S, Subhedar, NV, Garner, P, Neilson, JP, Harigopal, S. Betamimetics for inhibiting preterm labour. Cochrane Database Syst Rev 2004 18; CD004352.Google Scholar
36Tsoi, E, Akmal, S, Rane, S, Otigbah, C, Nicolaides, KH. Ultrasound assessment of cervical length in threatened preterm labor. Ultrasound Obstet Gynecol 2003; 21: 552–55.CrossRefGoogle ScholarPubMed
37Alfirevic, Z, Allen-Coward, H, Molina, F, Vinuesa, CP, Nicolaides, K. Targeted therapy for threatened preterm labor based on sonographic measurement of the cervical length: a randomized controlled trial. Ultrasound Obstet Gynecol 2007; 29: 4750.CrossRefGoogle ScholarPubMed
38Lockwood, CJ, Senyei, AE, Dische, MR, Casal, D, Shah, KD, Thung, SN et al. Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. N Engl J Med 1991; 325: 669–74.CrossRefGoogle ScholarPubMed
39Tsoi, E, Akmal, S, Geerts, L, Jeffery, B, Nicolaides, KH. Sonographic measurement of cervical length and fetal fibronectin testing in threatened preterm labor. Ultrasound Obstet Gynecol 2006; 27: 368–72.CrossRefGoogle ScholarPubMed
40Gomez, R, Romero, R, Medina, L, Nien, JK, Chaiworapongsa, T, Carstens, M et al. Cervicovaginal fibronectin improves the prediction of preterm delivery based on sonographic cervical length in patients with preterm uterine contractions and intact membranes. Am J Obstet Gynecol 2005; 192: 350–59.CrossRefGoogle ScholarPubMed
41Schmitz, T, Maillard, F, Bessard-Bacquaert, S, Kayem, G, Fulla, Y, Cabrol, D et al. Selective use of fetal fibronectin detection after cervical length measurement to predict spontaneous preterm delivery in women with preterm labor. Am J Obstet Gynecol 2006; 194: 138–43.CrossRefGoogle ScholarPubMed
42French, JI, McGregor, JA. The pathobiology of premature rupture of membranes. Semin Perinat 1996; 40: 344–68.CrossRefGoogle Scholar
43Schucker, JL, Mercer, BM. Midtrimester premature rupture of the membranes. Semin Perinatol 1996; 20: 389400.CrossRefGoogle ScholarPubMed
44Yang, SH, Choi, SJ, Roh, CR, Kim, JH. Multiple courses of antenatal corticosteroid therapy in patients with preterm premature rupture of membranes. J Perinat Med 2004; 32: 4248.CrossRefGoogle ScholarPubMed
45Vermillion, ST, Soper, DE, Chasedunn-Roark, J. Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes. Am J Obstet Gynecol 1999; 181: 320–27.CrossRefGoogle ScholarPubMed
46Abbasi, S, Hirsch, D, Davis, J, Tolosa, J, Stouffer, N, Debbs, R et al. Effect of single versus multiple courses of antenatal corticosteroids on maternal and neonatal outcome. Am J Obstet Gynecol 2000; 182: 1243–249.CrossRefGoogle ScholarPubMed
47Lee, MJ, Davies, J, Guinn, D, Sullivan, L, Atkinson, MW, McGregor, S et al. Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes. Obstet Gynecol 2004; 103: 274–81.CrossRefGoogle ScholarPubMed
48Hecher, K, Bilardo, CM, Stigter, RH, Ville, Y, Hackeloer, BJ, Kok, HJ et al. Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18: 564–70.CrossRefGoogle ScholarPubMed
49Baschat, AA, Gembruch, U, Harman, CR. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrasound Obstet Gynecol 2001; 18: 571–77.CrossRefGoogle ScholarPubMed
50Zlatnik, MG, Cheng, YW, Norton, ME, Thiet, M, Caughey, AB. Placenta previa and the risk of preterm delivery. J Matern Fetal Neonatal Med 2007; 20: 719–23.CrossRefGoogle ScholarPubMed
51Leung, TY, Chan, LW, Tam, WH, Leung, TN, Lau, TK. Risk and prediction of preterm delivery in pregnancies complicated by antepartum hemorrhage of unknown origin before 34 weeks. Gynecol Obstet Invest 2001; 52: 227–31.CrossRefGoogle ScholarPubMed
52NIH Consensus Conference. Effect of Corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273: 413–18.CrossRefGoogle Scholar
53Ballard, PL and Liggins, GC. Glucocorticoid activity in cord serum: comparison of hydrocortisone and betamethasone regimens. J Pediatr 1982; 101: 468–70.CrossRefGoogle ScholarPubMed
54Ballard, PL. Hormones and lung maturation. In: Monographs on endocrinology, Vol 28. Berlin: Springer-Verlag, 1986; 1–345.CrossRefGoogle Scholar
55Howie, RN, Liggins, CC. The New Zealand study of antepartum glucocorticoid treatment. In: PM, Farrell (ed). Lung development: biological and clinical perspectives, vol 2. New York: Academic Press, 1982: 255–65.Google Scholar
56Jobe, AH, Soll, RF. Choice and dose of corticosteroid for antenatal treatments. Am J Obstet Gynecol 2004; 190: 878–81.CrossRefGoogle ScholarPubMed
57Derks, JB, Giussani, DA, Van Dam, LM, Jenkins, SL, Winter, JA, Zhao, XF et al. Differential effects of betamethasone and dexamethasone fetal administration of parturition in sheep. J Soc Gynecol Investig 1996; 3: 336–41.CrossRefGoogle ScholarPubMed
58Bar-Lev, MR, Maayan-Metzger, A, Matok, I, Heyman, Z, Sivan, E, Kuint, J. Short-term outcomes in low birth weight infants following antenatal exposure to betamethasone versus dexamethasone. Obstet Gynecol 2004; 104: 484–88.CrossRefGoogle ScholarPubMed
59Baud, O, Foix-L'Helias, L, Kaminski, M, Audibert, F, Jarreau, PH, Papiernik, E et al. Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants. N Engl J Med 1999; 341: 1190–196.CrossRefGoogle ScholarPubMed
60Elimian, A, Garry, D, Figueroa, R, Spitzer, A, Wiencek, V, Quirk, JG. Antenatal betamethasone compared with dexamethasone (betacode trial): a randomized controlled trial. Obstet Gynecol 2007; 110: 2630.CrossRefGoogle ScholarPubMed