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Antenatal corticosteroids reduce respiratory distress syndrome in certain infants

An infant’s risk of neonatal respiratory distress syndrome was lowered if a woman took certain steroids more than 34 weeks into her pregnancy, according to data published in The BMJ.

The researchers also found that a single dose of corticosteroids could be beneficial for women at risk for premature delivery between 34 weeks and 36 weeks, 6 days gestation, and for women undergoing a planned cesarean delivery 37 weeks gestation or later.

“Women [in these time frames] … should be counseled by the doctors about the availability of steroids to decrease the risk of lung disease in their neonates,” Vincent Berghella, MD, of the department of obstetrics and gynecology, Thomas Jefferson University, Philadelphia, told Healio Family Medicine.

Berghella and Gabriele Saccone, MD, of the University of Naples Federico II, Italy, conducted a systematic review and meta-analysis using data from six trials including 5,698 non-multiple birth pregnancies. Three trials involved 2,498 planned cesarean deliveries at 37 weeks or later. The remaining three trials involved 3,200 women at 34 weeks through 36 weeks, 6 days gestation and likely to have a preterm birth.

According to researchers, infants of women who received antenatal corticosteroids at greater than 34 weeks had a significantly lower risk for respiratory distress syndrome (RDS) (RR = 0.74; 95% CI, 0.61-0.91), mild RDS (RR = 0.67; 95% CI, 0.46-0.96), moderate RDS (RR = 0.39; 95% CI, 0.18-0.89) and severe RDS (RR = 0.55; 95% CI, 0.33-0.91). Infants of women who received antenatal betamethasone at 34 weeks through 36 weeks, 6 days of their pregnancy had a significantly lower incidence of severe RDS (RR = 0.6; 95% CI, 0.33-0.94). Infants of women undergoing planned cesarean delivery at greater than 37 weeks’ gestation who received prophylactic corticosteroids 48 hours before delivery had a significantly lower risk of RDS (RR = 0.4; 95% CI, 0.27-0.59), mild RDS (RR = 0.43; 95% CI, 0.26-0.72) and moderate RDS (RR = 0.4, 0.18-0.88).

The researchers noted their research revealed a greater likelihood of neonatal hypoglycemia in babies born to women who received corticosteroids more than 34 weeks into their pregnancy.

“[A]n important question is whether the short-term benefits showed by this meta-analysis might be associated with any long-term benefits or risks,” Berghella and Saccone wrote. “In this context, the increase in the incidence of neonatal hypoglycemia is particularly worrisome, especially since neonatal hypoglycemia has been reported to be the only independent risk factor for later developmental delay and physical growth deficits among moderate or late preterm infants.”

However, researchers wrote hypoglycemia rates were comparable to the general population of late preterm infants and no adverse events were reported. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.