title: Maternal side-effects after multiple courses of antenatal corticosteroids (MACS): the three-month follow-up of women in the randomized controlled trial of MACS for preterm birth study.
abstract: OBJECTIVE
  A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or birth, whichever came first. The primary outcome of the study, a composite of neonatal mortality and morbidity, was similar for the multiple ACS and placebo groups (12.9% vs. 12.5%), but infants exposed to multiple courses of ACS weighed less, were shorter, and had smaller head circumferences. Thus for women who remain at increased risk of preterm birth, multiple courses of ACS (every 14 days) are not recommended. Chronic use of corticosteroids is associated with numerous side effects including weight gain and depression. The aim of this postpartum assessment was to ascertain if multiple courses of ACS were associated with maternal side effects.
  
  
  METHODS
  Three months postpartum, women who participated in MACS were asked to complete a structured questionnaire that asked about maternal side effects of corticosteroid use during MACS and included the Edinburgh Postnatal Depression Scale. Women were also asked to evaluate their study participation.
  
  
  RESULTS
  Of the 1858 women randomized, 1712 (92.1%) completed the postpartum questionnaire. There were no significant differences in the risk of maternal side effects between the two groups. Large numbers of women met the criteria for postpartum depression (14.1% in the ACS vs. 16.0% in the placebo group). Most women (94.1%) responded that they would participate in the trial again.
  
  
  CONCLUSIONS
  In pregnancy, corticosteroids are given to women for fetal lung maturation and for the treatment of various maternal diseases. In this international multicentre randomized controlled trial, multiple courses of ACS (every 14 days) were not associated with maternal side effects, and the majority of women responded that they would participate in such a study again.
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Kellie E
authors.initials: KE
authors.lastname: Murphy
authors.forename: Mary E
authors.initials: ME
authors.lastname: Hannah
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Willan
authors.forename: Arne
authors.initials: A
authors.lastname: Ohlsson
authors.forename: Edmond N
authors.initials: EN
authors.lastname: Kelly
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Matthews
authors.forename: Saroj
authors.initials: S
authors.lastname: Saigal
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Asztalos
authors.forename: Sue
authors.initials: S
authors.lastname: Ross
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Delisle
authors.forename: Laura
authors.initials: L
authors.lastname: Tomat
authors.forename: Kofi
authors.initials: K
authors.lastname: Amankwah
authors.forename: Patricia
authors.initials: P
authors.lastname: Guselle
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
authors.forename: B Anthony
authors.initials: BA
authors.lastname: Armson
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000328:Adult; D000339:Affect / Q000187:drug effects; D001724:Birth Weight / Q000187:drug effects; D019052:Depression, Postpartum / Q000453:epidemiology; D005260:Female; D005325:Fetal Organ Maturity; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000196:embryology; D017060:Patient Satisfaction; D010919:Placebos; D011247:Pregnancy; D047928:Premature Birth; D011644:Puerperal Disorders / Q000139:chemically induced; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control
chemical_list: D000305:Adrenal Cortex Hormones; D010919:Placebos