Antenatal steroids (ANS) are proven strategies to maximize outcomes of premature neonates without any major maternal side effects. Their use results in decreased incidence of neonatal mortality and major morbidities (respiratory distress syndrome, early onset sepsis, necrotizing enterocolitis, and intraventricular hemorrhage). However, due to concerns of long-term adverse effect (early onset hypertension and poor neurological outcome), a close follow-up is required. Similarly, due to lack of long-term follow-up data and potential risk of hypoglycemia, a cautious use is recommended in late preterms and elective cesareans. There is currently no consensus regarding preferential use of one ANS over the other. The current review therefore tried to address these issues for use of ANS in Indian prospective in light of recent emerging evidence. Due to better safety profile, lesser side effects, lower cost, and easy storage, we recommend dexamethasone as a steroid of choice for antenatal prophylaxis.
AlthabeF, HowsonCP, KinneyM, LawnJ.World Health Organization. Born too soon: the global action report on preterm birth [Internet]. 2012. http://www.who.int/pmnch/media/news/2012/201204%5Fborntoosoon-report.pdf
2.
LeeACC, KatzJ, BlencoweH, . National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1(1):e26-36.
3.
SharmaPK, SankarMJ, SapraS, . Growth and neurosensory outcomes of preterm very low birth weight infants at 18 months of corrected age. Indian J Pediatr. 2011;78(12):1485-1490.
4.
MukhopadhyayK, MahajanR, LouisD, NarangA.Longitudinal growth of very low birth weight neonates during first year of life and risk factors for malnutrition in a developing country. Acta Paediatr. 2013;102(3):278-281.
5.
MukhopadhyayK, MalhiP, MahajanR, NarangA.Neurodevelopmental and behavioral outcome of very low birth weight babies at corrected age of 2 years. Indian J Pediatr. 2010;77(9):963-967.
6.
BarrosFC, BhuttaZA, BatraM, HansenTN, VictoraCG, Group.Rubens CE; GAPPS ReviewGlobal report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions. BMC Pregnancy Childbirth. 2010;10 Suppl 1(Suppl 1):S3.
7.
RobertsD, BrownJ, MedleyN, DalzielSR.Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017;3:CD004454.
8.
Infant Survival in Hospitals of India (VISHI) Study InvestigatorsVLBW, MurkiS, KumarN, ChawlaD, . Variability in survival of very low birth weight neonates in hospitals of India. Indian J Pediatr. 2015;82(6):565-567.
9.
WaltherFJ, David-CuR, MehtaEI, PolkDH, JobeAH, IkegamiM.Higher lung antioxidant enzyme activity persists after single dose of corticosteroids in preterm lambs. Am J Physiol. 1996;271(2 Pt 1):L187-191.
10.
O’BrodovichHM.Immature epithelial Na+ channel expression is one of the pathogenetic mechanisms leading to human neonatal respiratory distress syndrome. Proc Assoc Am Physicians. 1996;108(5):345-355.
11.
BallardPL, BallardRA.Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. Am J Obstet Gynecol. 1995;173(1):254-262.
12.
Salem NajibNM.Pharmacokinetics of betamethasone after single-dose intramuscular administration of betamethasone phosphate and betamethasone acetate to healthy subjects. Clin Ther. 2012;34(1):214-220.
13.
HochhausG, BarthJ, al-FayoumiS, SuarezS, DerendorfH, HochhausR, MöllmannH.Pharmacokinetics and pharmacodynamics of dexamethasone sodium-m-sulfobenzoate (DS) after intravenous and intramuscular administration: a comparison with dexamethasone phosphate (DP). J Clin Pharmacol. 2001;41(4):425-434.
14.
DaniC, VestriV, BertiniG, PratesiS, RubaltelliFF.Toxicity of corticosteroids and catecholamines for mice neuronal cell cultures: Role of preservatives. J Matern Fetal Neonatal Med. 2007;20(4):325-333.
15.
LigginsGC, HowieRN.A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972;50(4):515-525.
16.
DeshmukhM, PatoleS.Antenatal corticosteroids in impending preterm deliveries before 25 weeks’ gestation. Arch Dis Child Fetal Neonatal Ed. 2018;103(2):F173-F176.
17.
DeshmukhM, PatoleS.Antenatal corticosteroids for impending late preterm (34-36+6 weeks) deliveries—A systematic review and meta-analysis of RCTs. PLoS One. 2021;16(3):e0248774.
18.
StutchfieldP, WhitakerR, RussellIAntenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ. 2005;331(7518):662.
19.
CrowtherCA, McKinlayCJ, MiddletonP, HardingJE.Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev. 2015;(7):CD003935.
20.
CrowtherCA, MiddletonPF, VoyseyM, . Effects of repeat prenatal corticosteroids given to women at risk of preterm birth: an individual participant data meta-analysis. PLoS Med. 2019;16(4):e1002771.
21.
BrownfootFC, GagliardiDI, BainE, MiddletonP, CrowtherCA.Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2013;8:CD006764.
MelamedN, ShahJ, SoraishamA, YoonEW, LeeSK, ShahPS, MurphyKE.Association between antenatal corticosteroid administration-to-birth interval and outcomes of preterm neonates. Obstet Gynecol. 2015;125(6):1377-1384.
24.
Committee on Obstetric Practice. Committee Opinion No. 713: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2017;130:e102-e109.
25.
GLOWM. Antenatal corticosteroids to reduce neonatal morbidity and mortality: RCOG Green-top Guideline. Lond RCOG [Internet]. 2010. https://www.glowm.com/pdf/Antenatal%20Corticosteroids%20to%20Reduce%20Neonatal%20Morbidity.pdf. Accessed September 15, 2021.
26.
World Health Organization. WHO recommendations on interventions to improve preterm birth outcomes. WHO; 2015. https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guideline/en/. Accessed September 15, 2021.
27.
NICE. Recommendations | Preterm Labour and Birth | Guidance | NICE [Internet]. https://www.nice.org.uk/guidance/ng25/chapter/Recommendations#maternal-corticosteroids. Accessed September 15, 2021.
28.
National Health Mission. Use of antenatal corticosteroids in preterm labour [Internet]. https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1182&lid=364. Accessed September 15, 2021.
29.
Gyamfi-BannermanC, ThomEA, BlackwellSC, . Antenatal betamethasone for women at risk for late preterm delivery. NICHD Maternal-Fetal Medicine Units Network. N Engl J Med. 2016;374:1311-1320.
30.
SotiriadisA, MakrydimasG, PapatheodorouS, IoannidisJP, McGoldrickE.Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev. 2018;8:CD006614.
31.
AlthabeF, BelizánJM, McClureEM, . A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial. Lancet. 2015;385(9968):629-639.
32.
WHO ACTION Trials Collaborators. The World Health Organization ACTION-I (Antenatal CorTicosteroids for Improving Outcomes in preterm Newborns) Trial: a multi-country, multi-centre, two-arm, parallel, double-blind, placebo-controlled, individually randomized trial of antenatal corticosteroids for women at risk of imminent birth in the early preterm period in hospitals in low-resource countries. Trials. 2019;20(1):507.
