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Technical Update No. 439: Antenatal Corticosteroids at Late Preterm Gestation

Published:December 23, 2022DOI:https://doi.org/10.1016/j.jogc.2022.12.006

      ABSTRACT

      Objective

      To update recommendations for administration of antenatal corticosteroids in the late preterm period.

      Target Population

      Pregnant individuals at risk of preterm birth from 34 to 366 weeks gestation.

      Options

      Administration or non-administration of a single course of antenatal corticosteroids at 34 to 366 weeks gestation.

      Outcomes

      Neonatal morbidity (respiratory distress, hypoglycemia), long-term neurodevelopment, and other long-term outcomes (growth, cardiac/metabolic, respiratory).

      Benefits, Harms, and Costs

      Administration of antenatal corticosteroids from 34 to 366 weeks gestation decreases the risk of neonatal respiratory distress but increases the risk of neonatal hypoglycemia. The long-term impacts of antenatal corticosteroid administration from 34 to 366 weeks gestation are uncertain.

      Evidence

      For evidence on the neonatal effects of antenatal corticosteroid administration at late preterm gestation, we summarized evidence from the 2020 Cochrane review of antenatal corticosteroids and combined this with evidence from published randomized trials identified by searching Ovid MEDLINE from January 1, 2020, to May 11, 2022. Given the absence of direct evidence on the impact of late preterm antenatal corticosteroid administration on neurodevelopmental outcomes, we summarized evidence on the impact of antenatal corticosteroids across gestational ages on neurodevelopmental outcomes using the following sources: (1) the 2020 Cochrane review; and (2) evidence obtained by searching Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to January 5, 2022. We did not apply date or language restrictions. Given the absence of direct evidence on the impact of late preterm antenatal corticosteroid administration on other long-term outcomes, we summarized evidence on the impact of antenatal corticosteroids across gestational ages on other long-term outcomes by combining findings from the 2020 Cochrane review with evidence obtained by searching Ovid MEDLINE for observational studies related to long-term cardiometabolic, respiratory, and growth effects of antenatal corticosteroids from inception to October 22, 2021. We reviewed reference lists of included studies and relevant systematic reviews for additional references. See Appendix A for search terms and summaries.

      Validation Methods

      The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix B (Tables B1 for definitions and B2 for interpretations of strong and conditional [weak] recommendations).

      Intended Audience

      Maternity care providers, including midwives, family physicians, and obstetricians.

      Keywords

      ABBREVIATIONS:

      aOR (adjusted odds ratio), ACS (antenatal corticosteroids), ALPS (Antenatal Late Preterm Steroids), CI (confidence interval), ECMO (extracorporeal membrane oxygenation), IVH (intraventricular hemorrhage), OR (odds ratio), RCT (randomized controlled trial), RDS (respiratory distress syndrome), RR (risk ratio), WHO (World Health Organization)
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