50 Years of Antenatal Corticosteroids: A Systematic Review

Abstract

Summary The administration of antenatal corticosteroids (ACS) to accelerate fetal lung maturation is considered one of the most valuable antenatal therapies in preterm labour. Although early indications that administering antenatal corticosteroids has a positive impact on fetal lung maturation and despite the widespread recommendations to use this treatment in women at risk of preterm birth, there is still some uncertainty regarding its effectiveness, particularly in lower-resource settings and in high-risk groups such as women with hypertension or multiple pregnancies. The optimal timing of administration has not improved in over 50 years. This assessment aimed to evaluate the effects of administering a course of corticosteroids to women before anticipated preterm birth (before 37 weeks of pregnancy) on fetal and neonatal morbidity and mortality, maternal mortality and morbidity, and the child’s health later in life. It is advised that clinicians only administer a single course of ACS in high-risk cases of preterm birth likely to occur within the next seven days, and the gestational age is between 22+0 and 33+6 weeks. The diagnosis of preterm labour should be made based on available resources and expertise and supported by comprehensive protocols in the relevant setting.