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Neonatal and Maternal Outcomes of Lower Versus Standard Doses of Antenatal Corticosteroids for Women at Risk of Preterm Delivery: A Systematic Review of Randomized Controlled Trials

Published:March 26, 2020DOI:https://doi.org/10.1016/j.jogc.2020.02.127

      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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