Multiple courses of antenatal glucocorticoid treatment and fetal outcome.
Thanks to the US National Institutes of Health Consensus Conference, the odds of antenatal use of glucocorticoids for preventing severe neonatal complications of premature delivery have significantly increased these last years. The belief that neonatal benefits last up to 7 days after the first course and administration of further courses is safe has led many obstetricians to prescribe multiple antenatal glucocorticoid courses. Whether multiple courses offer an advantage over a single course has not been demonstrated. In contrast, there are accumulating evidence suggesting that this practice may have short and long-term side effects. The potential benefits and side effects of multiple antenatal courses of glucocorticoids, extrapolated from experimental data and observational studies, are detailed in this review. Until the results of ongoing randomized trials with long term follow-up are available, the practice of giving multiple courses of glucocorticoids to women should be considered with the greatest caution.
Department of Pediatrics and Neonatology, Hospital Antoine-Béclère, Clamart, France. thierry.lacaze@abc.ap-hop-paris.fr
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Lacaze-Masmonteil
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Audibert
D000818:Animals; D001921:Brain / Q000187:drug effects / Q000196:embryology; D005314:Embryonic and Fetal Development / Q000187:drug effects; D005260:Female; D005325:Fetal Organ Maturity / Q000187:drug effects; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008168:Lung / Q000196:embryology; D011247:Pregnancy; D011256:Pregnancy Outcome
D005938:Glucocorticoids