A consensus panel convened by the National Institutes of Health has reaffirmed the importance of single-course treatment with corticosteroids for pregnant women at risk for pre-term delivery. However, the panel concluded that current data do not support the routine use of repeat courses of this treatment.
Corticosteroids are hormones produced by the adrenal gland. Synthesized corticosteroids, when given to pregnant women, accelerate the maturation of specific organs, including the lungs, in the fetus.
In 1994, virtually the same panel that met today concluded, in part, that single course administration of corticosteroids to pregnant women at risk for preterm delivery reduces the risk of death, respiratory distress syndrome, and brain hemorrhage in their preterm infants. The 1994 panel noted, however, that the potential benefits and risks of administering more than one course of antenatal corticosteroids during a pregnancy were unknown and called for additional research on this issue.
The panel reconvened on August 17 and 18, 2000 at the Bethesda, MD campus of the NIH for the consensus conference titled Antenatal Corticosteriods Revisited: Repeat Courses. The conference was sponsored by the National Institute of Child Health and Human Development and the NIH Office of Medical Applications of Research. Cosponsors included the National Institute of Nursing Research and the National Heart, Lung, and Blood Institute.
"In recent years, our recommendation for administering corticosteroids to pregnant women at high risk for pre-term delivery has been widely adopted," said panel chair Larry Gilstrap, M.D., of the University of Texas-Houston Medical School. "However, there is increasing evidence that clinicians are administering repeat courses of corticosteroids."
The 16-member panel concluded the current data are insufficient to support the routine use of repeat courses of antenatal corticosteroids. In reviewing the public presentations and published literature, they noted that there are potential benefits and risks of repeat courses. In terms of benefits, some studies of limited quality suggest a reduction of respiratory distress syndrome and patent ductus arteriosis, an abnormality of the vascular system. In terms of risks, some studies suggest an increase in psychomotor delay and in behavioral problems. The effect of repeat versus single course steroids on neonatal mortality is also unknown.
In reaffirming their 1994 recommendation, the panel stated that all pregnant women between 24 and 34 weeks of gestation, at risk of preterm delivery within seven days, should be considered for single course antenatal corticosteroid treatment. In today's statement they recommended that repeat courses of antenatal corticosteroids should be reserved for patients enrolled in randomized controlled studies. However, they emphasized that the design of these studies should minimize the exposure of mothers and their fetuses to corticosteroids. Moreover, they called for studies to assess the effects of repeat courses of corticosteroids on fetal and postnatal growth as well as on long-term effects on growth and neuropsychological development.