Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth

Consult Expert Advice

Evidence supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. A single course of antenatal corticosteroids could be considered routine for preterm delivery (1).

Maternal corticosteroids (2)

• for women between 23+0 and 23+6 weeks of pregnancy who are in suspected or established preterm labour, are having a planned preterm birth or have preterm premature rupture of membranes (P-PROM)
  • discuss with the woman (and her family members or carers as appropriate) the use of maternal corticosteroids in the context of her individual circumstances
• for women between 24+0 and 33+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labour, are having a planned preterm birth or have P-PROM
  • offer maternal corticosteroids
• for women between 34+0 and 35+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labour, are having a planned preterm birth or have P-PROM
  • consider maternal corticosteroids

Do not routinely offer repeat courses of maternal corticosteroids, but take into account:

the interval since the end of last course

gestational age

the likelihood of birth within 48 hours

Infants born preterm (before 37 weeks' gestation) are at risk of respiratory distress syndrome (RDS) and need for respiratory support due to lung immaturity (3)

• one course of prenatal corticosteroids, administered to women at risk of preterm birth, reduces the risk of respiratory morbidity and improves survival of their infants
• a systematic review found that short term benefits for babies included less respiratory distress and fewer serious health problems in the first few weeks after birth with repeat dose(s) of prenatal corticosteroids for women still at risk of preterm birth >=7 days after an initial course

Reference:

• Roberts D et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.Cochrane Database Syst Rev. 2017 Mar 21;3:CD004454
• NICE (August 2019).Preterm labour and birth
• Walters A, McKinlay C, Middleton P, Harding JE, Crowther CA. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD003935. DOI: 10.1002/14651858.CD003935.pub5