Multiple courses of antenatal corticosteroids: A systematic review and meta-analysis

doi:10.1067/mob.2001.117635

American Journal of Obstetrics and Gynecology

Volume 185, Issue 5, November 2001, Pages 1073-1080

Presented at the Twenty-first Annual Meeting of the Society for Maternal-Fetal Medicine, Reno, Nev, February 5-10, 2001.

https://doi.org/10.1067/mob.2001.117635 Get rights and content

Abstract

Objective: To assess the effects of multiple courses of antenatal corticosteroids on perinatal and neonatal death and neonatal, infant, and maternal disease. Methods: MEDLINE and Embase were searched for human studies published in English. Studies that compared multiple courses of antenatal corticosteroids versus a single course were included if they were published in full and were controlled for gestational age at birth. Meta-analyses (odds ratio and 95% confidence interval) were undertaken when possible. Results: Eight observational studies were included. Selection bias was present in all studies. Multiple courses of antenatal corticosteroids were associated with a decreased risk of respiratory distress syndrome (odds ratio, 0.79; 95% confidence interval, 0.64 to 0.98) and patent ductus arteriosus (odds ratio, 0.56; 95% confidence interval, 0.35 to 0.90) and were associated with an increased risk of endometritis (odds ratio, 3.42; 95% confidence interval, 1.92 to 6.11). There was no significant effect on other neonatal and maternal outcomes. Conclusion: It is not possible to establish the true effects of multiple courses of antenatal corticosteroids by a review of the results of observational studies because of the effect of confounding variables. Randomized controlled trials are needed to address this important issue. (Am J Obstet Gynecol 2001;185:1073-80.)

Section snippets

Methods

We searched MEDLINE (1966 to 1999) and Embase (1980 to 1999) using the following strategy. For the MEDLINE search, we combined the terms adrenal cortex hormones, glucocorticoids, betamethasone, and dexamethasone to identify corticosteroid therapy with lung, fetal organ maturity, and respiratory distress syndrome, and we used the same terms again with pregnancy and pregnancy complications in 2 separate sets to identify all related articles. We used a similar search strategy for Embase. We also

Results

Eight studies met the inclusion criteria for this systematic review.11, 12, 13, 14, 15, 16, 17, 18 These studies included 1682 fetuses who were exposed to a single course of ACS and 1116 fetuses who were exposed to multiple courses of ACS. All studies were retrospective, although for 1 study the 3-year outcomes were assessed prospectively,¹⁴ and for another study the data were collected as part of a prospective randomized controlled trial of thyrotropin-releasing hormone.¹² The characteristics

Comment

It has been shown in randomized controlled trials that a single course of ACS decreases the risk of RDS, intraventricular hemorrhage, and death in preterm babies.³ Corticosteroids are known to accelerate maturation of developmentally regulated proteins and to stimulate cytodifferentiation in numerous cells, including type II pneumnocytes. However, the effects of a single course of ACS on lung maturation may be a temporary phenomenon.⁶ In the Cochrane meta-analysis, the benefits of a single

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Another study found that severe stress in mothers increased the risk of congenital malformations in children, especially of the cranial neural crest type (Hansen et al., 2000). The long-term effects of fetal glucocorticoid exposure in humans have been poorly examined, due to the fact that the studies were often small or had short duration of follow up (Aghajafari et al., 2001). To our knowledge, our study is the first population-based study to investigate the association between prenatal stress and subsequent epilepsy risk.
To examine whether prenatal exposure to maternal bereavement is associated with an increased risk of epilepsy in the first decades of life.
We conducted a population-based cohort study of children (N = 1,553,966) born in Denmark from 1978 to 2004. A total of 39,867 children born to women who lost a close relative while pregnant or within 1 year before the pregnancy were included in the exposed cohort. The main outcome of interest was hospitalization due to epilepsy (ICD 8 codes 345.00–345.99, ICD 10 codes G40.0–G41.9). We used log-linear Poisson models to estimate incidence rate ratios (IRRs).
The exposed children had a risk of epilepsy similar to that of unexposed children (IRR 1.06, 95% CI 0.96–1.18). The IRRs were 1.08 (95% CI 0.89–1.31) for the children of women who lost a child, and 1.02 (95% CI 0.91–1.15) for the children of women who lost a partner, parent or sibling. The IRRs did not differ according to the timing of exposure or the causes of death (unexpected causes and other causes).
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Conocer cómo se trata la amenaza de parto pretérmino (APP) en los hospitales españoles.
Con el patrocinio de la Sociedad Española de Ginecología y Obstetricia, se realizó una encuesta por Internet sobre aspectos básicos del tratamiento de la APP en 41 hospitales españoles, 37 públicos y 4 privados.
Todos los hospitales realizan tocólisis en la APP antes de las 34 semanas. El tocolítico más empleado es el atosiban (73,7%), seguido de los betamiméticos (21,9%) y el nifedipino (4,9%). En las APP de más de 24 semanas sólo el 7,3% de los hospitales realizan tocólisis. El 100% de los hospitales administra corticoides para acelerar la madurez pulmonar. El 92,7% utiliza betametasona y el 7,3% restante, dexametasona. El 90% de los hospitales no realiza corticoterapia de repetición. En los embarazos múltiples todos emplean la misma dosis que en las APP con feto único.
El tocolítico más utilizado en los hospitales españoles es el atosiban y el corticoide preferido, la betametasona.
To determine how threatened preterm labor is treated in Spanish hospitals.
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All hospitals use tocolysis in threatened preterm labor before 34th weeks. The most widely used tocolytic agent is atosiban (73,7%), followed by betamimetics (21.9%) and nifedipine (4.9%). Only 7.3% of the hospitals use tocolytics in threatened preterm labor after 34 weeks. All the hospitals use corticosteroids to accelerate lung maturation: 92.7% use betamethasone and 7.3% prefer dexamethasone. In 90% of the hospitals, steroid therapy is not repeated. In multiple pregnancies, the same steroid dose as that used in single pregnancies is administrated in all centers.
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This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
This article has been retracted at the request of the Editor-in-Chief.
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Endocr. Res., 30 (2004) 827–836, http://dx.doi.org/10.1081/ERC-200044091;
Trends Endocrinol. Metab., 13 (2002) 373–380, http://dx.doi.org/10.1016/S1043-2760(02)00690-2;
Stress, 7 (2004) 15–27, http://dx.doi.org/10.1080/10253890310001650277;
Fetal Matern. Med. Rev., 14 (2003) 329–354, http://dx.doi.org/10.1017/S0965539503001141;
Endocr. Res., 28 (2002) 709–718, http://dx.doi.org/10.1081/ERC-120016991.
One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any material should be appropriately cited and quoted. As such this article represents a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process.
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The last 10 years have already seen improvements in the short- and long-term prognosis for premature neonates. Nevertheless, progress in the prenatal evaluation of predictive factors for neonatal diseases and more detailed and reliable knowledge of fetal physiology could allow the development of new treatments with consequent expectations of further improvements in the prognosis for such premature newborns. Global strategies for the management of preterm labour, ranging from a policy for prenatal transfer to centres offering the appropriate level of perinatal care, should continue to be expanded, and long-term evaluations must also be continued.
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^☆: Fariba Aghajafari holds a University of Toronto Open Fellowship. Mary E. Hannah holds a CIHR Senior Scientist Award.

^☆☆: Reprint requests: Fariba Aghajafari, MD, University of Toronto Maternal, Infant, and Reproductive Health Research Unit, Center for Research in Women’s Health, Suite 751, 790 Bay St, Toronto, ON M5G 1N8. E-mail: [email protected].

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Transactions of the Twenty-First Annual Meeting of the Society for Maternal-Fetal Medicine—ContinuedMultiple courses of antenatal corticosteroids: A systematic review and meta-analysis☆,☆☆

Abstract

Section snippets

Methods

Results

Comment

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Epidemiology of preterm birth

Epidemiol Review

Determinants of preterm birth rates in Canada from 1981 through 1983 and from 1992 through 1994

N Engl J Med

Corticosteroids prior to preterm delivery (Cochrane review)

effect of corticosteroids for fetal maturation on perinatal outcomes

Am J Obstet Gynecol

A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants

Pediatrics

Use of corticosteroids by Australian obstetricians—a survey of clinical practice

Aust N Z J Obstet Gynaecol

Use of antenatal corticosteroids (ANCS) in USA [abstract]

Am J Obstet Gynecol

Are we prescribing multiple courses of antenatal corticosteroids? A survey of practice in the UK

Br J Obstet Gynaecol

Transactions of the Twenty-First Annual Meeting of the Society for Maternal-Fetal Medicine—Continued
Multiple courses of antenatal corticosteroids: A systematic review and meta-analysis☆,☆☆