Abstract
Objective
Our objective was to systematically review randomized and quasi-randomized trials
on the neonatal and maternal effects of lower doses of antenatal corticosteroids (<24
mg of betamethasone or dexamethasone) compared with standard double doses of antenatal
corticosteroids (24 mg of betamethasone or dexamethasone) administered to women at
risk of preterm delivery.
Data Sources
Medline, Embase, CINAHL, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, the
WHO International Clinical Trials Registry Platform, and the Australia New Zealand
Clinical Trials Registry were searched from inception to December 8, 2019.
Study Selection
A total of 2401 titles, abstracts, and protocols were independently screened by two
reviewers, and subsequently 113 full-text articles were reviewed.
Data Extraction
Our primary outcomes were perinatal death and severe respiratory distress syndrome.
Data Synthesis
We identified one large in-progress trial comparing 11.4 mg versus 22.8 mg betamethasone
and one published randomized controlled trial that compared a lower dose of dexamethasone
(16 mg) to a standard dose of betamethasone (24 mg). The only relevant data from the
published trial suggests minor changes in fetal heart rate variability between baseline
and 24- to 48-hour follow-up between the two groups. Data for other outcomes had to
be excluded due to the administration of weekly courses of antenatal corticosteroids.
Conclusions
Randomized trial data comparing lower doses of antenatal corticosteroids to standard
double doses are scarce. Given concerns regarding current antenatal corticosteroids
dosing patterns, there is an urgent need for randomized controlled trials examining
lower versus standard double doses of antenatal corticosteroids.
Résumé
Objectif
Notre objectif était d'effectuer une revue systématique d'essais randomisés et quasi
randomisés sur l'incidence néonatale et maternelle de la corticothérapie prénatale
(CP) à faible dose (< 24 mg de bétaméthasone ou de dexaméthasone) par rapport à la
CP standard en 2 doses (24 mg de bétaméthasone ou de dexaméthasone) administrées aux
femmes qui risquent d'accoucher avant terme.
Sources de données
Des recherches ont été effectuées dans les bases de données Medline, Embase, CINAHL,
Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, le Système d'enregistrement
international des essais cliniques de l'OMS et le registre des essais cliniques d'Australie
et de Nouvelle-Zélande, de leur création jusqu'au 8 décembre 2019.
Sélection des études
Au total, 2 401 titres, résumés et protocoles ont été examinés de façon indépendante
par deux évaluateurs. Par la suite, 113 articles en version intégrale ont été examinés.
Extraction des données
Les critères de jugement principaux étaient la mort périnatale et le syndrome de détresse
respiratoire sévère.
Synthèse des données
Nous avons recensé un vaste essai en cours comparant l'administration de 11,4 mg de
bétaméthasone par rapport à 22,8 mg et un essai clinique randomisé publié qui a comparé
la dexaméthasone à faible dose (16 mg) à la dose standard de bétaméthasone (24 mg).
Les seules données pertinentes de l'essai publié indiquent des changements mineurs
dans la variabilité de la fréquence cardiaque fœtale entre la fréquence cardiaque
fœtale de base et la fréquence au suivi de 24 à 48 heures entre les deux groupes.
Les données relatives à d'autres issues ont dû être exclues en raison de l'administration
de cures hebdomadaires de CP.
Conclusions
Les données d'essais randomisés comparant la CP à faible dose à la CP standard en
2 doses sont rares. Compte tenu des préoccupations concernant les schémas posologiques
de la CP, il est urgent d'effectuer des essais cliniques randomisés pour comparer
la CP à faible dose à la CP standard en 2 doses.
Keywords
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Article info
Publication history
Published online: March 26, 2020
Footnotes
Disclosures: Sarah D. McDonald is supported by the Canadian Institutes of Health Research Canada Research Chair (950-229920). However, the Canadian Institutes of Health Research were not involved in any aspect of this study.
All authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
