Antenatal corticosteroids: the good, the bad and the unknown.
OBJECTIVE
The purpose of this review was to summarize recently published clinical and animal-based studies of antenatal corticosteroids, describe current recommendations for practice, and suggest priority areas for future research.


RESULTS
A single course of antenatal corticosteroids is known to improve newborn lung function after preterm birth and to reduce the risk of newborn death. Current evidence from animal and clinical studies suggests that additional numbers of courses do not further improve lung function and are associated with risks of adverse consequences. These risks principally include restricted intrauterine growth, altered brain development, postnatal insulin resistance and changes to the hypothalamic-pituitary-adrenal axis.


CONCLUSIONS
The research challenges in this field are now centred on uncovering the mechanisms by which cortisol is involved in programming the fetus for its future metabolic life, and discovering ways in which the effectiveness and safety of antenatal glucocorticoids can be enhanced.
Newnham
John P
JP
The School of Women's Health and Infants' Health, The University of Western Australia, King Edward Memorial Hospital, Perth, Western Australia, Australia. jnewnham@obsgyn.uwa.edu.au
Moss
Timothy J M
TJ
Nitsos
Ilias
I
Sloboda
Deborah M
DM
D002543:Cerebral Hemorrhage / Q000517:prevention & control; D005314:Embryonic and Fetal Development / Q000187:drug effects; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control
D005938:Glucocorticoids