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      Antenatal Corticosteroids for Late Preterm Labor

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          ABSTRACT

          This article reviews several different aspects of corticosteroids in preterm labor (PTL). After a short review of the history of the administration of corticosteroids for preterm labor, we review the overall data on PTL.

          The next paragraph is on repeated courses of corticosteroids in PTL. Most of the literature does not show benefits from such repeated dosages. Furthermore, some like the large multiple courses of antenatal corticosteroids (MACS) study showed that repeated dosages resulted in smaller babies. What was probably more important was that it resulted in small head conferences, most likely reflecting smaller head sizes.

          There is ample literature on the effect of corticosteroids on different organ systems. We do not have good data on the long-term outcomes of this effect. A very long-term study on the original study of Liggins showed some effect on glucose tolerance but no effect on frank diabetes. It is difficult to use these issues in determining the need for corticosteroids as there is always a concern that a long-term effect may be found years later (look at the ORACLE study mentioned here).

          There is limited information on the effect of corticosteroids in the late preterm labor. The data is summarized in a table. Two of these papers are on administrating corticosteroids prior to a cesarean section (CS) and are discussed separately. Of the studies on the administration of corticosteroids for late PTL, one stands out. It was done by the maternal fetal medicine (MFM) network in the US, it is large and well-designed. It showed a decrease in both respiratory distress syndrome (RDS) by close to 50% and shortened the stay in the neonatal intensive care unit (NICU) by an average of 8 days. The price was an increase in GDM.

          These were the reasons that both the society of maternal fetal medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) recommended the use of corticosteroids in late preterm. No other society came forward with such recommendations probably because of the concern for long-term effects.

          How to cite this article

          Farine D, Shah P, Murphy KE. Antenatal Corticosteroids for Late Preterm Labor. Donald School J Ultrasound Obstet Gynecol 2023;17(2):143–148.

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          Most cited references37

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          Effect of corticosteroids for fetal maturation on perinatal outcomes.

          (2025)
          The National Institutes of Health Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes brought together specialists in obstetrics, neonatology, pharmacology, epidemiology, and nursing; basic scientists in physiology and cellular biology; and the public to address the following questions: (1) For what conditions and purposes are antenatal corticosteroids used, and what is the scientific basis for that use? (2) What are the short-term and long-term benefits of antenatal corticosteroid treatment? (3) What are the short-term and long-term adverse effects for the infant and mother? (4) What is the influence of the type of corticosteroid, dosage, timing and circumstances of administration, and associated therapy on treatment outcome? (5) What are the economic consequences of this treatment? (6) What are the recommendations for use of antenatal corticosteroids? and (7) What research is needed to guide clinical care? Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. The consensus panel concluded that antenatal corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome, and intraventricular hemorrhage in preterm infants. These benefits extend to a broad range of gestational ages (24-34 weeks) and are not limited by gender or race. Although the beneficial effects of corticosteroids are greatest more than 24 hours after beginning treatment, treatment less than 24 hours in duration may also improve outcomes. The benefits of antenatal corticosteroids are additive to those derived from surfactant therapy. In the presence of preterm premature rupture of the membranes, antenatal corticosteroid therapy reduces the frequency of respiratory distress syndrome, intraventricular hemorrhage, and neonatal death, although to a lesser extent than with intact membranes. Whether this therapy increases either neonatal or maternal infection is unclear. However, the risk of intraventricular hemorrhage and death from prematurity is greater than the risk from infection. Data from trials with followup of children up to 12 years indicate that antenatal corticosteroid therapy does not adversely affect physical growth or psychomotor development. Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health.
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            Effectiveness of antenatal corticosteroids in reducing respiratory disorders in late preterm infants: randomised clinical trial.

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              A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster randomised trial.

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                Author and article information

                Journal
                DSJUOG
                Donald School Journal of Ultrasound in Obstetrics and Gynecology
                Donald School J Ultrasound Obstet Gynecol
                Jaypee Brothers Medical Publishers
                0973-614X
                0975-1912
                April-June 2023
                : 17
                : 2
                : 143-148
                Affiliations
                [1,3 ]Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
                [2 ]Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
                Author notes
                Dan Farine, Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada, Phone: 1-416-586-8592, e-mail: dan.farine@ 123456sinaihealth.ca
                Article
                10.5005/jp-journals-10009-1975
                a52454aa-5ee7-4c12-bd7d-f586eac34948
                Copyright © 2023; The Author(s).

                © The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 March 2023
                : 30 April 2023
                : 30 June 2023
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                dsjuog-17-143.pdf

                Obstetrics & Gynecology
                Gestational diabetes,Corticosteroids,Late preterm labor,Preterm labor
                Obstetrics & Gynecology
                Gestational diabetes, Corticosteroids, Late preterm labor, Preterm labor

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