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Am J Perinatol 2011; 28(1): 033-044
DOI: 10.1055/s-0030-1262509
© Thieme Medical Publishers

Effects of Antenatal Corticosteroids Given Prior to 26 Weeks' Gestation: A Systematic Review of Randomized Controlled Trials

Wes Onland1 , Monique W. de Laat3 , Ben Willem Mol3 , Martin Offringa1 , 2 , 4
  • 1Department of Neonatology, Emma Children's Hospital, Amsterdam, The Netherlands
  • 2Department of Pediatric Clinical Epidemiology, Emma Children's Hospital, Amsterdam, The Netherlands
  • 3Department of Obstetrics, Academic Medical Center, Amsterdam, The Netherlands
  • 4University of Amsterdam, Amsterdam, The Netherlands
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Publication History

Publication Date:
20 July 2010 (online)

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ABSTRACT

Although it is generally accepted that antenatal corticosteroids reduce neonatal complications after preterm labor, it is unclear at what gestational age this effect starts to occur. We conducted a systematic review of the literature to determine the effects of antenatal corticosteroids given to women at risk of preterm birth <26 weeks' gestation. Two reviewers independently searched electronic databases and the Cochrane Library for randomized controlled trials including women at imminent birth at a gestational age <26 weeks. Nine randomized trials were included. Meta-analyses and meta-regression of trials including participants with a lower gestational age revealed no significant reduction of neonatal mortality and morbidity in the corticosteroid group as compared with nonintervention, in contrast to clear evidence of beneficial effects in trials including women given corticosteroids at a later gestational age. A gestational age-dependent effect of antenatal corticosteroids on neonatal outcomes with lesser treatment benefits in patients <26 weeks' gestational age appears to exist. There is no evidence from randomized controlled trials to support or refute the recommendation of administrating antenatal corticosteroids to women at risk of preterm birth <26 weeks' gestation.

KEYWORDS

Corticosteroids - antenatal - preterm - respiratory distress syndrome

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Monique W de LaatM.D. Ph.D. 

Academic Medical Center, University of Amsterdam, Obstetrics and Gynaecology (H4-205)

Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Email: m.w.delaat@amc.uva.nl

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