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Is it safe? · Pregnancy Smart

When are steroids given for a baby's lung development?

Assigned clinical reviewerMatt Stahl· PharmDDraft · pending clinical reviewUpdated

What does the evidence say about antenatal steroid timing for fetal lung maturity during pregnancy?

  1. ACOG recommends one corticosteroid course from 24 0/7 through 33 6/7 weeks when preterm delivery within 7 days is likely, including pregnancies with ruptured membranes or multiples. 1
  2. ACOG and SMFM now allow consideration at 22 0/7 through 22 6/7 weeks when neonatal resuscitation is planned, but describe the recommendation as weak and based on low-quality observational evidence. 2
  3. ACOG reports that benefit is greatest 2 to 7 days after the first dose and advises against routinely scheduled serial courses; one repeat course may be considered before 34 weeks when renewed delivery risk and interval criteria are met. 1
  4. In the randomized ALPS trial of 2,827 late-preterm infants, the respiratory-support or early-death composite was 11.6% after betamethasone and 14.4% after placebo; neonatal hypoglycemia was more frequent after betamethasone, 24.0% versus 15.0%. 3
  5. A Cochrane review of 27 randomized studies found lower perinatal death, neonatal death, respiratory distress syndrome, and probably intraventricular hemorrhage after antenatal corticosteroids, while noting uncertainty in very early, very late, and other understudied subgroups. 4

Is antenatal steroid timing for fetal lung maturity safe in each trimester?

  • First trimester. Antenatal corticosteroids are not used in the first trimester for fetal lung maturation. The decision arises only when birth is expected very early and neonatal support is being planned.
  • Second trimester. At 22 0/7 through 22 6/7 weeks, corticosteroids may be considered only after counseling when neonatal resuscitation is planned. From 24 0/7 weeks, one course is recommended when delivery within 7 days is likely.
  • Third trimester. From 34 0/7 through 36 6/7 weeks, one betamethasone course is recommended for qualifying patients at risk of birth within 7 days who have not had a prior course. An indicated delivery should not be delayed solely to finish the course.

Frequently asked questions

What is the ideal interval between antenatal steroids and delivery?

Antenatal corticosteroid benefit is greatest when birth occurs 2 to 7 days after the first dose. ACOG also reports meaningful benefit when less than 24 hours is available, so a first dose may still be given when completing the course looks unlikely.

Are steroids given for every episode of possible preterm labor?

Antenatal corticosteroids are not automatic for every contraction or preterm-labor evaluation. ACOG ties use to substantial concern that delivery will occur within 7 days, because many people assessed for possible preterm labor do not give birth in the optimal window.

What weeks are antenatal corticosteroids usually given?

Antenatal corticosteroids are routinely recommended from 24 0/7 through 33 6/7 weeks when birth within 7 days is likely. Selected use may begin at 22 weeks with a resuscitation plan, and a qualifying late-preterm course may be given from 34 0/7 through 36 6/7 weeks.

Can an antenatal steroid course be repeated if birth does not happen?

Antenatal corticosteroids are not placed on an automatic repeat schedule. ACOG allows one repeat course before 34 weeks when delivery is again likely within 7 days and the prior course was more than 14 days earlier, with an earlier rescue interval possible in a specific clinical scenario.

Do late-preterm babies receive the same steroid medicine?

Late-preterm evidence comes from betamethasone. The ALPS trial used two injections 24 hours apart in singleton pregnancies at 34 0/7 through 36 5/7 weeks with high delivery likelihood. ACOG limits this recommendation to patients without a previous antenatal corticosteroid course.

What newborn benefits have antenatal steroid studies measured?

Antenatal corticosteroid studies have measured neonatal and perinatal death, respiratory distress syndrome, respiratory support, intraventricular hemorrhage, surfactant use, and other newborn outcomes. The Cochrane findings reflect pooled trial averages, not a guarantee for one infant.

What is the main late-preterm tradeoff with betamethasone?

Late-preterm betamethasone lowered the ALPS trial's respiratory-support or early-death composite, but neonatal hypoglycemia was more frequent. The trial excluded several groups, including people with pregestational diabetes, prior corticosteroid exposure, and multiple gestations, so its result does not apply automatically to them.

Should delivery be delayed so the steroid course can be completed?

An indicated late-preterm delivery should not be postponed solely to complete antenatal corticosteroids, and ACOG does not advise using medicines to delay late-preterm delivery for that purpose. The obstetric reason for delivery remains central to the timing decision.

Related in the library

References

  1. Antenatal Corticosteroid Therapy for Fetal Maturation

    ACOG · https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/antenatal-corticosteroid-therapy-for-fetal-maturation

  2. Use of Antenatal Corticosteroids at 22 Weeks of Gestation

    ACOG · https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/09/use-of-antenatal-corticosteroids-at-22-weeks-of-gestation

  3. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

    PubMed · https://pubmed.ncbi.nlm.nih.gov/26842679/

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