Benefits, Harms, and Costs
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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Publication stageIn Press Journal Pre-Proof
SOGC TECHNICAL UPDATE, No. 439 August 2023 (replaces No. 364, September 2018)
It is the Society of Obstetricians and Gynaecologists of Canada (SOGC) policy to review the content 5 years after publication, at which time the document may be revised to reflect new evidence or the document may be archived.
(En français : Mise à jour technique no 439 : Corticothérapie prénatale en période de prématurité tardive)
The English document is the original version. In the event of any discrepancy between the English and French content, the English version prevails.
This clinical practice guideline was prepared by the authors and overseen by the SOGC Maternal Fetal Medicine (MFM) Committee. It was reviewed by the SOGC Clinical Practice – Obstetrics Committee and approved by the SOGC Guideline Management and Oversight Committee.
This technical update supersedes No. 364, published in September 2018.
Acknowledgement: The authors would like to acknowledge and thank special contributor Prubjot Gill, MLIS, Vancouver, BC.
Disclosures: Statements were received from all authors. No relationships or activities that could involve a conflict of interest were declared. All authors have indicated that they meet the journal’s requirements for authorship.
Subject Categories: Obstetrics, Maternal Fetal Medicine
This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Patients have the right and responsibility to make informed decisions about their care in partnership with their health care provider. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate, and personalized. The values, beliefs, and individual needs of each patient in the context of their personal circumstances should be considered and the final decision about care and treatment options chosen by the patient should be respected.
Language and inclusivity: The SOGC recognizes the importance to be fully inclusive and when context is appropriate, gender-neutral language will be used. In other circumstances, we continue to use gendered language because of our mission to advance women’s health. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person’s needs.
Weeks Gestation Notation: The authors follow the World Health Organization’s notation on gestational age: the first day of the last menstrual period is day 0 (of week 0); therefore, days 0 to 6 correspond to completed week 0, days 7 to 13 correspond to completed week 1, etc. The authors support the use of first trimester crown rump length as the ideal parameter for determining accurate gestational age (as per SOGC guideline No. 388 – Determination of Gestational Age by Ultrasound) when considering recommendations in this Technical Update.
RECOMMENDED CHANGES IN PRACTICE
1. Antenatal corticosteroids should continue to be strongly recommended up to 336 weeks gestation when delivery is expected within 7 days.
2. From 34 to 366 weeks gestation, antenatal corticosteroids should be considered, based on absolute harms, and benefits specific to the gestational week; this consideration may be facilitated by the clinician decision support tool included in this technical update.
3. From 34 to 366 weeks gestation, antenatal corticosteroids are not recommended for pregnancies complicated by pre-gestational diabetes.
1. Administration of antenatal corticosteroids at late preterm gestation decreases the risk of neonatal respiratory morbidity, but increases the risk of neonatal hypoglycemia.
2. The absolute benefits of antenatal corticosteroids decrease with each advancing week in the late preterm period (i.e., 34 to 36 weeks gestation).
3. The impact of late preterm antenatal corticosteroids on neurodevelopment or other long-term outcomes remains uncertain due to the absence of direct evidence for these outcomes.
Figure 2 (pending). Clinician decision support tool for antenatal corticosteroid administration in the late preterm period.