Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment in 2 trials and unclear blinding in one trial).
A Cochrane review (abstract [Abstract], review [Abstract]) included 11 studies with 4 895 women and 5 975 babies. Treatment of women who remain at risk of preterm birth (before 34 weeks' gestation) 7 or more days after an initial course of prenatal corticosteroids with repeat dose(s) of corticosteroid reduced the risk of neonate respiratory distress syndrome (RDS) (RR 0.82, 95% CI 0.74 to 0.90; 9 trials, 3540 infants, numbers needed to treat (NNT) 17, 95% CI 11 to 29) and serious infant morbidity (RR 0.88, 95% CI 0.80 to 0.97; 9 trials, 5 736 infants, NNT 39, 95% CI 24 to 158).At early or mid-childhood follow-up no statistically significant differences were seen for infants exposed to repeat prenatal corticosteroids compared with unexposed infants for the primary outcomes (total deaths; survival free of any disability or major disability; disability; or serious outcome) or in the secondary outcome growth assessments.
A preplanned secondary analysis of data from the multicenter Australasian Collaborative Trial of Repeat Doses of Corticosteroids (ACTORDS) 3 assessing the neurocognitive function included 988 children at age of 6 to 8 years. The fetal growth restriction (FGR) rate was 28.2% in the repeated betamethasone treatment group and 24.6% in the placebo group (P = .20). Primary outcome rates of survival free of any disability and death or survival with moderate to severe disability were similar between treatment groups for the FGR and non-FGR subgroups.
Primary/Secondary Keywords