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Evidence summaries

Repeated Exposure to Antenatal Corticosteroids

Repeat dose(s) of antenatal corticosteroids appear to reduce the neonatal respiratory distress syndrome and other morbidity, however it may reduce birthweight. Level of evidence: "B"

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.

    References

    • Walters A, McKinlay C, Middleton P et al. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2022;(4):CD003935. [PubMed]
    • Cartwright RD, Crowther CA, Anderson PJ et al. Association of Fetal Growth Restriction With Neurocognitive Function After Repeated Antenatal Betamethasone Treatment vs Placebo: Secondary Analysis of the ACTORDS Randomized Clinical Trial. JAMA Netw Open 2019;2(2):e187636. [PubMed]

Primary/Secondary Keywords