Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing?

Lenka Hrabalkova, Tsukasa Takahashi, Matthew W. Kemp, Sarah J. Stock

Research output: Contribution to journalReview article

Abstract

Background: Between 5-15% of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood.

Aims: This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticos-teroids and the evidence of potential harm to offspring are also summarised.

Results: Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recom-mended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal.

Conclusion: Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.

Original languageEnglish
Pages (from-to)593-600
Number of pages8
JournalCurrent Pharmaceutical Design
Volume25
Issue number5
DOIs
Publication statusPublished - 2019

Cite this

Hrabalkova, Lenka ; Takahashi, Tsukasa ; Kemp, Matthew W. ; Stock, Sarah J. / Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing?. In: Current Pharmaceutical Design. 2019 ; Vol. 25, No. 5. pp. 593-600.
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title = "Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing?",
abstract = "Background: Between 5-15{\%} of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood.Aims: This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticos-teroids and the evidence of potential harm to offspring are also summarised.Results: Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recom-mended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal.Conclusion: Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.",
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Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing? / Hrabalkova, Lenka; Takahashi, Tsukasa; Kemp, Matthew W.; Stock, Sarah J.

In: Current Pharmaceutical Design, Vol. 25, No. 5, 2019, p. 593-600.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Antenatal Corticosteroids for Fetal Lung Maturity - Too Much of a Good Thing?

AU - Hrabalkova, Lenka

AU - Takahashi, Tsukasa

AU - Kemp, Matthew W.

AU - Stock, Sarah J.

PY - 2019

Y1 - 2019

N2 - Background: Between 5-15% of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood.Aims: This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticos-teroids and the evidence of potential harm to offspring are also summarised.Results: Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recom-mended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal.Conclusion: Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.

AB - Background: Between 5-15% of babies are born prematurely worldwide, with preterm birth defined as delivery before 37 completed weeks of pregnancy (term is at 40 weeks of gestation). Women at risk of preterm birth receive antenatal corticosteroids as part of standard care to accelerate fetal lung maturation and thus improve neonatal outcomes in the event of delivery. As a consequence of this treatment, the entire fetal organ system is exposed to the administered corticosteroids. The implications of this exposure, particularly the long-term impacts on offspring health, are poorly understood.Aims: This review will consider the origins of antenatal corticosteroid treatment and variations in current clinical practices surrounding the treatment. The limitations in the evidence base supporting the use of antenatal corticos-teroids and the evidence of potential harm to offspring are also summarised.Results: Little has been done to optimise the dose and formulation of antenatal corticosteroid treatment since the first clinical trial in 1972. International guidelines for the use of the treatment lack clarity regarding the recom-mended type of corticosteroid and the gestational window of treatment administration. Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Lastly, there is limited evidence regarding the long-term effects on the different fetal organ systems exposed in utero, particularly when the timing of corticosteroid administration is sub-optimal.Conclusion: Further investigations are urgently needed to determine the most safe and effective treatment regimen for antenatal corticosteroids, particularly regarding the type of corticosteroid and optimal gestational window of administration. A clear consensus on the use of this common treatment could maximise the benefits and minimise potential harms to offspring.

KW - Antenatal

KW - corticosteroids

KW - glucocorticoids

KW - betamethasone

KW - dexamethasone

KW - pregnancy

KW - preterm birth

KW - RESPIRATORY-DISTRESS-SYNDROME

KW - HEART-RATE-VARIABILITY

KW - PRETERM BIRTH

KW - GLUCOCORTICOID TREATMENT

KW - PRENATAL EXPOSURE

KW - MATERNAL CORTISOL

KW - GESTATIONAL-AGE

KW - DNA METHYLATION

KW - BLOOD-PRESSURE

KW - TERM OUTCOMES

U2 - 10.2174/1381612825666190326143814

DO - 10.2174/1381612825666190326143814

M3 - Review article

VL - 25

SP - 593

EP - 600

JO - Current Pharmaceutical Design

JF - Current Pharmaceutical Design

SN - 1381-6128

IS - 5

ER -