No Help, No Harm from Extra Steroids in Pregnancy

Corticosteroids for preemies not effective for multiple doses

(RxWiki News) Some pregnant women are at higher risk than others for having their baby too early. These women are often given a medication to reduce risks to their babies.

A recent study found that receiving additional doses of corticosteroid therapy neither helped nor hurt the women's babies over the long-term.

Corticosteroid therapy may be recommended when a woman is at risk for delivering her baby after 24 to 33 weeks of pregnancy. This medication can help premature babies have healthier lungs when they are born. A full-term pregnancy is typically between 37 and 42 weeks.

The children of women who received additional corticosteroid therapy turned out similarly five years later as children whose mothers did not receive more corticosteroids.

"Attend all prenatal appointments."

This study was led by Elizabeth V. Asztalos, MD, of The Centre for Mother, Infant and Child Research at Sunnybrook Research Institute in Toronto, Canada.

The researchers wanted to find out if it was safe and effective to give a second dose of corticosteroid therapy to women at risk for delivering their babies early.

The researchers wondered whether these women and their children might benefit from another course of corticosteroid therapy.

The researchers split 1,858 pregnant women into two groups. The women were all between 25 and 32 weeks of pregnancy, had received one course of corticosteroid therapy and were still at risk for giving birth early.

One group received two doses of corticosteroid therapy with betamethasone a day apart. They continued to receive this therapy every two weeks until they were 33 weeks pregnant.

The women in the other group received injections with a placebo, or a fake medicine.

The researchers then followed up with the families five years later, collecting information for 1,719 children. In that time, 93 of the children had died.

The researchers assessed the children's brain and behavioral function, as well as whether they had cerebral palsy or any hearing or vision problems.

The researchers looked for these conditions in case the corticosteroids had negatively affected the children's brain or nerve development.

The researchers found that neither group of children had a greater risk of dying or having long-term neurodevelopmental disability.

Among the 848 children whose mothers received only one dose of corticosteroid therapy, 25 percent (210 children) experienced long-term brain or developmental disabilities or died.

Likewise, 25 percent of the 871 children whose mothers received multiple courses of corticosteroid therapy (217 children) had long-term brain or developmental disabilities or died.

The researchers therefore determined that additional courses of corticosteroid therapy did not lead to harm among the children, but it did not benefit them either.

"Because of a lack of strong conclusive evidence of short-term or long-term benefits, it remains our opinion that multiple courses not be recommended in women with ongoing risk of preterm birth," the researchers concluded.

These findings match up with what has been learned since corticosteroids were first introduced for women at risk of giving birth early.

"When steroids were initially introduced for the treatment of preterm lung maturation in women at risk of delivering early, the initial recommendation was that they receive an intramuscular injection of steroids once weekly," said Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC. "This was standard during my residency in the mid 90s."

But times have changed, he said.

"Subsequently, it has been determined that the additional injections beyond the initial course do not provide additional benefit to the unborn child while possibly subjecting the mother to additional risks of side effects," Dr. Hall said. "This one-time treatment course is the current recommendation throughout the US."

This study was published October 14 in the journal JAMA Pediatrics. The research was funded by the Canadian Institutes of Health Research. The authors declared no conflicts of interest.

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Review Date: 
October 14, 2013