In high-income countries it is now standard practice to administer corticosteroids in cases where a woman is at high likelihood of imminently delivering significantly preterm (28–34 weeks gestation).
This treatment accelerates fetal lung development and reduces risk of respiratory distress syndrome, one of the most common life-threatening complications of prematurity. The treatment has been demonstrated in high- and middle-income settings with NICU services to significantly reduce risk of death. However, these results have not translated to lower income settings.
the year that antenatal corticosteriods (ACS) were first used to accelerate fetal lung maturation in threatened preterm birth
In lower income settings lacking sophisticated care, available evidence suggests that treatment with antenatal corticosteroids is not only less effective but actually increases likelihood of death of the fetus or newborn as well as of infection in the mother. This effect appears to be primarily a result of steroids being administered for cases that go on to deliver at term or close to term.
There may also be less lung maturation benefit for preterms in settings where a large proportion of pregnancies are affected by poor fetal nutrition and associated growth restriction and stress to the developing fetus. Further research is underway to determine in what circumstances corticosteroids can safely be used with expected significant benefit. In the meantime, this treatment should not be used unless safety can be assured.
Key resources on these topics
- 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.
- Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews.
- Caution on corticosteroids for preterm delivery: learning from missteps