Download PDF
Am J Perinatol 2001; 18(5): 267-278
DOI: 10.1055/s-2001-16989
ORIGINAL ARTICLES

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Single Versus Repeated-Course Antenatal Corticosteroids: Outcomes in Singleton and Multiple-Gestation Pregnancies

Daniel R. Dirnberger1 , Bradley A. Yoder1 3 4 , Michael C. Gordon2
  • 1Department of Pediatrics, Wilford Hall Medical Center, Lackland AFB, Texas
  • 2Department of Obstetrics and Gynecology, Wilford Hall Medical Center, Lackland AFB, Texas
  • 3Department of Pathology, University of Texas Health Science Center, San Antonio, Texas
  • 4Magella Medical Associates, Dallas, Texas
Further Information

Publication History

Publication Date:
10 September 2001 (online)

    Permissions and Reprints

ABSTRACT

The objectives of this study are to compare the neonatal risks and benefits of antenatal single-course versus repeated-course corticosteroids in singleton and multiple-gestation pregnancies. A comprehensive analysis was performed of the inpatient records of all neonates admitted to our center from 1 January 1994 through 31 May 1999. The primary outcome measure was survival without chronic lung disease (CLD). Secondary outcome measures included birth weight; head circumference; interval weight ratios; respiratory disease severity; intraventricular hemorrhage rate and severity; severe retinopathy of prematurity; early infection; and hospital days. All singletons 27-32 completed weeks' gestation, and multiples 26-32 weeks' gestation, whose mothers had received betamethasone before delivery, were included. One hundred and fifteen singleton and 53 multiple-gestation infants (total 168) were stratified by multiplicity, gestational-age (≤29 or ≥30 weeks), and number of steroid courses. Repeated courses of antenatal betamethasone were not associated with greater survival without CLD, in either singleton- or multiple-gestation infants. In singletons there was no difference in any outcome measure between groups. In multiples, the only difference was greater postnatal weight gain in the lower gestation group. Mean birth head circumference was smaller in repetitively-treated singletons ≤29 weeks. There are no clinically significant neonatal benefits of repeated-course antenatal steroids in singletons ≥27 weeks estimated gestational age (EGA) or multiple-gestation infants ≥26 weeks EGA. Prospective randomized trials of single-course versus repetitive antenatal corticosteroid therapy are warranted.

KEYWORD

Repetitive antenatal steroids - repetitive antenatal corticosteroids - repeated-course antenatal corticosteroids - multiple-gestation pregnancies

REFERENCES

  • 1 National Institutes of Health Consensus Development Conference Panel. National Institutes of Health Consensus Development Conference Statement: effect of corticosteroids for fetal maturation on perinatal outcomes, February 28-March 2, 1994.  Am J Obstet Gynecol . 1995;  173 246-252
    CrossrefPubMedGoogle Scholar
  • 2 Liggins G C, Howie R N. A controlled trial of antepartum glucocorticoid therapy for the prevention of respiratory distress syndrome in preterm infants.  Pediatrics . 1972;  50 515-525
    PubMedGoogle Scholar
  • 3 Liggins G C. Premature delivery of fetal lambs infused with glucocorticoids.  J Endocrinol . 1969;  45 515-523
    CrossrefPubMedGoogle Scholar
  • 4 Schmidt P L, Sims M E, Strassner H T, Paul R H, Mueller E, McCart D. Effect of antepartum glucocorticoid administration upon neonatal respiratory distress syndrome and perinatal infection.  Am J Obstet Gynecol . 1984;  148 178-186
    PubMedGoogle Scholar
  • 5 Garite T J, Rumney P J, Briggs G G. A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation.  Am J Obstet Gynecol . 1992;  166 646-651
    CrossrefPubMedGoogle Scholar
  • 6 Doyle L W, Permezel M J, Kitchen W H. Is there a lower limit for birth-weight/gestational age and antenatal steroid therapy?.  Aust N Z J Obstet Gynaecol . 1992;  32 193-195
    PubMedGoogle Scholar
  • 7 Crowley P. Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972-1994.  Am J Obstet Gynecol . 1995;  173 322-335
    CrossrefPubMedGoogle Scholar
  • 8 Shankaran S, Bauer C R, Bain R, Wright L L, Zachary J. Relationship between antenatal steroid administration and grades III and IV intracranial hemorrhage in low birth weight infants. The NICHD Neonatal Research Network.  Am J Obstet Gynecol . 1995;  173 305-312
    CrossrefPubMedGoogle Scholar
  • 9 Spinillo A, Capuzzo E, Ometto A, Stronati M, Baltaro F, Iasci A. Value of antenatal corticosteroid therapy in preterm birth.  Early Hum Devel . 1995;  42 37-47
    PubMedGoogle Scholar
  • 10 Sun B, Jobe A H, Ridger E, Ikegami M. Single dose versus two doses of betamethasone for lung maturation in preterm rabbits.  Pediatr Res . 1993;  33 256-260
    PubMedGoogle Scholar
  • 11 Rennie H M, Wheater M, Cole T J. Antenatal steroid administration is associated with an improved chance of intact survival in preterm infants.  Eur J Pediatr . 1996;  155 576-579
    CrossrefPubMedGoogle Scholar
  • 12 Shankaran S, Bauer C R, Bain R, Wright L L, Zachary J. Prenatal and perinatal risk and protective factors for neonatal intracranial hemorrhage. The NICHD Neonatal Research Network.  Arch Pediatr Adolesc Med . 1996;  150 491-497
    PubMedGoogle Scholar
  • 13 Ballard P L, Ballard R A. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids.  Am J Obstet Gynecol . 1995;  153 254-262
    PubMedGoogle Scholar
  • 14 Chen B, Basil J B, Schefft G L, Cole F S, Sadovsky Y. Antenatal steroids and intraventricular hemorrhage after premature rupture of membranes at 24-28 weeks' gestation.  Am J Perinatol . 1997;  14 171-176
    PubMedGoogle Scholar
  • 15 Elimian A, Verma U, Canterino J, Shah J, Visintainer P, Tejani N. Effectiveness of antenatal steroids in obstetric subgroups.  Obstet Gynecol . 1999;  93 174-179
    CrossrefPubMedGoogle Scholar
  • 16 Ikegami M, Polk D H, Jobe A H. Effect of interval from fetal corticosteroid treatment to delivery on postnatal lung function of preterm lambs.  J Appl Physiol . 1996;  80 5891-5897
    PubMedGoogle Scholar
  • 17 American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 147: antenatal corticosteroid therapy for fetal maturation.  Int J Gynecol Obstet . 1995;  48 340-342
    CrossrefPubMedGoogle Scholar
  • 18 Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to prevent respiratory distress syndrome RCOG guideline No. 7. London: The College 1996
  • 19 Quinlivan J A, Evans S F, Dunlop S A, Beazley L D, Newnham J P. Use of corticosteroids by Australian obstetricians: a survey of clinical practice.  Aust N Z J Obstet Gynaecol . 1998;  38 1-7
    PubMedGoogle Scholar
  • 20 Ballard P L, Granberg P, Ballard R. Glucocorticoid levels in maternal and cord serum after prenatal betamethasone therapy to prevent respiratory distress syndrome.  J Clin Invest . 1975;  56 1548-1554
    PubMedGoogle Scholar
  • 21 Bradley B S, Kumar S P, Mehta P N, Ezhuthachan S G. Neonatal cushingoid syndrome resulting from serial courses of antenatal betamethasone.  Obstet Gynecol . 1994;  83 869-872
    PubMedGoogle Scholar
  • 22 Challis J R, Davies I J, Benirschde K, Hendrickx A G, Ryan K J. The effects of dexamethasone on plasma steroid levels and fetal adrenal histology in the pregnant rhesus monkey.  Endocrinology . 1974;  95 1300-1305
    PubMedGoogle Scholar
  • 23 French N P, Hagan R, Evans S F, Godfrey M, Newnham J P. Repeated antenatal corticosteroids: size at birth and subsequent development.  Am J Obstet Gynecol . 1999;  180 114-121
    PubMedGoogle Scholar
  • 24 Mariononi E, Korebrits C, Di Iorio R, Cosmi E V, Challis J RG. Effect of betamethasone in vivo on placental corticotropin-releasing hormone in human pregnancy.  Am J Obstet Gynecol . 1998;  178 770-778
    PubMedGoogle Scholar
  • 25 Ikegami M, Jobe A H, Newnham J, Polk D H, Willet K E, Sly P. Repetitive prenatal glucocorticoids improve lung function and decrease growth in preterm lambs.  Am J Respir Crit Care Med . 1997;  156 178-184
    CrossrefPubMedGoogle Scholar
  • 26 Pratt L, Magness R R, Phernetton T, Hendricks S K, Abbott D H, Bird I M. Repeated use of betamethasone in rabbits: effects of treatment variation on adrenal suppression, pulmonary maturation, and pregnancy outcome.  Am J Obstet Gynecol . 1999;  180 995-1005
    PubMedGoogle Scholar
  • 27 Vermillion S T, Soper D E, Chasedunn-Roark J. Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes.  Am J Obstet Gynecol . 1999;  181 320-327
    PubMedGoogle Scholar
  • 28 Stewart J D, Gonzalez C L, Christensen H D, Rayburn W F. Impact of multiple antenatal doses of betamethasone on growth and development of mice offspring.  Am J Obstet Gynecol . 1997;  177 1138-1144
    PubMedGoogle Scholar
  • 29 Stewart J D, Sienko A E, Gonzalez C L, Christensen H D, Rayburn W F. Placebo-controlled comparison between a single dose and a multidose of betamethasone in accelerating lung maturation of mice offspring.  Am J Obstet Gynecol . 1998;  179 1241-1247
    PubMedGoogle Scholar
  • 30 Polk D H, Ikegami M, Jobe A H, Sly P, Kohan R, Newnham J. Preterm lung function after retreatment with antenatal betamethasone in preterm lambs.  Am J Obstet Gynecol . 1997;  176 308-315
    PubMedGoogle Scholar
  • 31 Ghidini A, Salafia C M, Minior V K. Repeated courses of steroids in preterm membrane rupture do not increase the risk of histologic chorioamnionitis.  Am J Perinatol . 1997;  14 309-313
    PubMedGoogle Scholar
  • 32 Terrone D A, Rinehart B K, Ghodes P G, Roberts W E, Miller R C, Martin J N. Multiple courses of betamethasone to enhance fetal lung maturation do not suppress neonatal adrenal response.  Am J Obstet Gynecol . 1999;  180 1349-1353
    PubMedGoogle Scholar
  • 33 Pratt L, Waschbusch L, Ladd W, Gangnon R, Hendricks S K. Multiple versus single betamethasone therapy: neonatal and maternal effects.  J Reprod Med . 1999;  44 257-264
    PubMedGoogle Scholar
  • 34 Turrentine M A, Wilson P D, Wilkins I A. A retrospective analysis of the effect of antenatal steroid administration on the incidence of respiratory distress syndrome in preterm twin pregnancies.  Am J Perinatol . 1996;  13 351-354
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Quist-Therson E C, Myhr T L, Ohlsson A. Antenatal steroids to prevent respiratory distress syndrome: multiple gestation as an effect modifier.  Acta Obstet Gynecol Scand . 1999;  78 388-392
    CrossrefPubMedGoogle Scholar
  • 36 Yoder B A, Anwar M U, Clark R H. Early prediction of neonatal chronic lung disease: a comparison of three scoring methods.  Ped Pulmonol . 1999;  27 388-394
    PubMedGoogle Scholar
  • 37 Ment L R, Duncan C C, Ehrenkranz R A. Intraventricular hemorrhage in the preterm neonate: timing and cerebral blood flow changes.  J Pediatr . 1984;  104 419-425
    PubMedGoogle Scholar
  • 38 Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity.  Arch Opthalmol . 1990;  108 1408-1416
    PubMedGoogle Scholar
  • 39 Bullard S R, Donahue S P, Feman S S, Sinatra R B, Walsh W F. The decreasing incidence and severity of retinopathy of prematurity.  J Aapos . 1999;  3 46-52
    PubMedGoogle Scholar
  • 40 Slotkin T A, Zhang J, McCook E C, Seidler F J. Glucocorticoid administration alters nuclear transcription factors in fetal rat brain: implications for the use of antenatal steroids.  Brain Res Dev Brain Res . 1998;  111 11-24
    PubMedGoogle Scholar
  • 41 Jobe A H, Wada N, Berry L M. Single and repetitive maternal glucocorticoids exposures reduce fetal growth in sheep.  Am J Obstet Gynecol . 1998;  178 880-885
    CrossrefPubMedGoogle Scholar
  • 42 National Institutes of Health. Antenatal corticosteroids revisited: repeated courses.  NIH Consensus Statement . 2000;  17 1-10
    PubMedGoogle Scholar
      >