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ACOGUpdatesCommitteeOpiniononPreterm
Corticosteroids
RickiLewis,PhD

September27,2016

AnupdatedcommitteeopinionfromtheAmericanCollegeofObstetriciansandGynecologists(ACOG),published
intheOctoberissueofObstetrics&Gynecologyexpandsantenatalcorticosteroidrecommendationstosupport
betamethasoneadministrationtowomenathighriskforlatepretermbirth(340/7366/7weeks).
"Throughthenewcommitteeopinionweareexpandinganexistingtherapy,basedonrecentdata,toimprove
outcomesinmoreclinicalsettings.It'sanimportantstepingettingmoremothersandbabiesthecaretheyneedto
behealthy,"committeeopinioncoauthorYasserElSayed,MD,saidinanACOGnewsrelease.
TheOctober2016committeeopinionupdatesandreinforcestheApril4,2016,"PracticeAdvisoryonAntenatal
CorticosteroidAdministrationintheLatePretermPeriod."
TherecommendationsfollowconsiderationofdatafromtheAntenatalLatePretermSteroidstrial.
Corticosteroidsgivenlatepretermareassociatedwithadecreasedneedforrespiratorysupport,immediate
postnatalresuscitation,prolongedneonatalintensivecareunitstays,andfewerrespiratorycomplicationsthat
requiretheseinterventions.However,hypoglycemiaismorecommonamongnewbornspreviouslyexposedto
betamethasone.TheAprilpracticeadvisoryrecommendedmonitoringneonatalbloodglucose(consistentwiththe
AmericanAcademyofPediatrics).
Manystudiesstronglyassociateantenatalcorticosteroidadministrationwithlowerriskforandseverityoffetal
respiratorydistresssyndrome,intracranialhemorrhage,necrotizingenterocolitis,anddeath.Oneinvestigationthat
followedindividualsfor31yearsafterexposuretoasingledoseofbetamethasonefoundnoimpairmentof
cognitivefunctionorhealthrelatedqualityoflife.
Thecommitteeopinionaddressesmultiplegestationsafterpublicationofastudydemonstratingsimilarbenefitsin
singletonandtwinpregnancies.
Thenewcommitteeopinionupdatesthe2011committeeopinion,whichrecommendedasinglecourseof
corticosteroidsbetweenweeks24and34forwomenatriskforpretermdeliverywithin7days,andtowomenwith
prematureruptureofmembranes(PROM)before32weeks.Efficacyat32to33weekswasunclearatthattime.
Althoughregularrepeatdoseswerenotadvised,thereportrecommendedasinglerescuecourseifinitial
treatmentwasmorethan2weekspreviously,gestationalagewaslessthan326/7weeks,andbirthwaslikely
withinaweek.
"ThedocumentalsoreemphasizesACOG'srecommendationtoconsiderantenatalcorticosteroidsforpregnant
womenatriskofpretermdeliverystartingat23weeksofgestation,basedonafamily'sdecisionregarding
resuscitation,"accordingtoanACOGnewsrelease.Noeffectwasseenforadministrationat22weeks.
Cliniciansshouldnotoffercorticosteroidsincasesofintrauterineinfection,andshouldnotgivetocolyticstoextend
timetoadministerthedrugs,theopinionstates.
Multiplescheduledcoursesofcorticosteroidsareassociatedwithlowbirthweightsandarenotadvised.
ACOGrecommends:
Asinglecourseofcorticosteroidsbetween240/7and336/7weeks,includingwomenwithPROMand/or
multiplegestations,andpossiblybeginningat230/7weeksifatriskfordeliverywithin7days,consideringa
family'sdecision.

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Asinglecourseofbetamethasonebetween340/7weeksand366/7weeksforwomenatriskforpreterm
birthwithin7dayswhohavenotreceivedpreviouscorticosteroids.
Asinglerepeatcourseforcertainwomenlessthan340/7weekswithriskfordeliverywithinthenext7days
andpreviouscorticosteroidsmorethan14daysearlier,andinsomecasesasearlyas7daysfromtheprior
dose.
Thereisinsufficientevidencetorecommendfororagainstadministrationofarepeatorrescuedoseof
corticosteroidsinpatientswithPROM.
Continuedsurveillanceoflongtermoutcomes.
Becausebenefitfromcorticosteroidspeakswithinaweek,"itiscriticaltohaveongoingdevelopmentofstrategies
thatencouragetimelycorticosteroidadministrationtowomenatriskofdeliverywithinthenext7daysandavoid
overuseofcorticosteroidsforlowriskwomen,"theopinionconcludes.
AdditionalupdatedversionsofrelevantpracticebulletinsarepublishedwiththecommitteeopinionintheOctober
2016issueofObstetrics&Gynecology.
ObstetGynecol.2016128:e187e194.Fulltext
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Citethisarticle:ACOGUpdatesCommitteeOpiniononPretermCorticosteroids.Medscape.Sep27,2016.

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