New Guidelines Affirm Role of Antenatal Corticosteroids in Reducing Neonatal Complications
UK: The latest Green-top Guideline No. 74, published in BJOG: An International Journal of Obstetrics & Gynaecology, emphasizes the critical role of antenatal corticosteroids in improving neonatal outcomes for women at risk of preterm birth or undergoing cesarean delivery at term. These evidence-based recommendations aim to enhance care and reduce complications associated with prematurity, offering significant benefits to neonatal health.
Antenatal corticosteroids, when administered before anticipated preterm delivery, are among the most effective interventions to improve neonatal outcomes. They significantly reduce risks of neonatal respiratory distress syndrome (RDS), perinatal death, and other complications. Women between 24+0 and 34+6 weeks of gestation at imminent risk of preterm birth—due to established labor, preterm prelabor rupture of membranes (PPROM), or planned early delivery—are strongly advised to receive this treatment.
In multiple pregnancies, such as twins or triplets, targeted use of corticosteroids aligns with the recommendations for singletons. However, medical practitioners are cautioned against delaying necessary delivery to administer corticosteroids if the health of the mother or baby is at risk.
For women undergoing planned cesarean delivery between 37+0 and 38+6 weeks, healthcare providers are encouraged to discuss the potential risks and benefits of antenatal corticosteroids. While they may reduce neonatal respiratory morbidity and admissions to neonatal units, concerns remain about potential adverse effects, including neonatal hypoglycemia and developmental delays.
The timing of corticosteroid administration is pivotal. Studies reveal the greatest reduction in neonatal mortality, and RDS occurs when the first dose is given within seven days of delivery. Benefits extend even when administered within 48 or 24 hours before birth, highlighting the importance of timely treatment.
The guideline emphasizes that women with PPROM should receive corticosteroids due to their increased risk of preterm labor. However, healthcare providers are advised to weigh the timing and necessity of corticosteroid use carefully, ensuring that the treatment does not delay urgent deliveries needed for maternal or fetal well-being.
This updated guideline supplements earlier recommendations from the National Institute for Health and Care Excellence (NICE) and replaces the archived Green-top Guideline No. 7. It aims to guide healthcare providers, policymakers, and stakeholders in making informed decisions, improving neonatal outcomes, and mitigating the long-term impacts of prematurity.
The recommendations offer a balanced approach to antenatal corticosteroid use, emphasizing evidence-based care tailored to individual clinical scenarios to maximize benefits for mothers and their babies.
"Further research is needed to evaluate the effectiveness of antenatal corticosteroids in reducing neonatal morbidity when administered before elective cesarean birth at term. The optimal gestational age for administering corticosteroids remains controversial and requires additional investigation. Additionally, the safety and effectiveness of corticosteroids in multiple pregnancies, as well as in women with diabetes or chorioamnionitis, require further study," SJ Stock, Royal College of Obstetricians and Gynaecologists, London SE1 1SZ, and colleagues wrote.
"Research should also explore the effectiveness of lower corticosteroid doses compared to current regimens, as well as the potential off-target effects of various formulations and dosing schedules. Long-term follow-up studies are necessary to assess the effects of antenatal corticosteroids on cardiovascular function and neurodevelopment. Lastly, investigating sexual dimorphism in response to antenatal corticosteroids is an important area for future research," they concluded.
Reference:
Stock, S., Thomson, A., & Papworth, S. (2022). Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG: An International Journal of Obstetrics & Gynaecology, 129(8), e35-e60. https://doi.org/10.1111/1471-0528.17027
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