Abstract
Objective A single course of synthetic antenatal corticosteroids is standard care for women
considered to be at risk for preterm birth before 34 weeks of gestation. While the
intended target is the fetal lung, the fetal brain contains remarkably high levels
of glucocorticoid receptors in structures critical in the regulation of behavior and
endocrine function. Negative programming signals may occur which can lead to permanent
maladaptive changes and predispose the infant/child to an increased risk in physical,
mental, and developmental disorders.
Methods Framed around these areas of concerns for physical, mental, and developmental disorders,
this narrative review drew on studies (animal and clinical), evaluating the long-term
effects of antenatal corticosteroids to present the case that a more targeted approach
to the use of antenatal corticosteroids for the betterment of the fetus urgently needed.
Results Studies raised concerns about the potential negative long-term consequences, especially
for the exposed fetus who was born beyond the period of the greatest benefit from
antenatal corticosteroids. The long-term consequences are more subtle in nature and
usually manifest later in life, often beyond the scope of most clinical trials.
Conclusion Continued research is needed to identify sufficient safety data, both short term
and long term. Caution in the use of antenatal corticosteroids should be exercised
while additional work is undertaken to optimize dosing strategies and better identify
women at risk of preterm birth prior to administration of antenatal corticosteroids.
Key Points
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A single-course ACS is a remarkable therapy with substantial benefits.
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There is a potential of long-term neurodevelopmental consequences in the ACS-exposed
fetus.
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There is a need to improve dosing strategies and identification of appropriate at
risk women.
Keywords
antenatal corticosteroids - neurodevelopmental outcomes - long-term outcomes - term
infant - preterm infant
