Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2008 Oct 8:(4):CD006764.
doi: 10.1002/14651858.CD006764.pub2.

Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth

Fiona C Brownfoot  1 , Caroline A Crowther, Philippa Middleton
Affiliations
Meta-Analysis

Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth

Fiona C Brownfoot et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Despite the widespread use of antenatal corticosteroids to prevent respiratory distress syndrome in preterm infants, there is currently no consensus as to the type of corticosteroid to use; nor the dose, frequency or timing of use or the route of administration.

Objectives: To assess the effects of different corticosteroid regimens for women at risk of preterm birth.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008).

Selection criteria: Randomised and quasi-randomised controlled trials of antenatal corticosteroid regimens in women at risk of preterm birth.

Data collection and analysis: Two authors assessed trial quality and extracted the data independently.

Main results: Ten trials (1089 women and 1161 infants) were included. Dexamethasone decreased the incidence of intraventricular haemorrhage compared with betamethasone (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.21 to 0.92; four trials, 549 infants). No statistically significant differences were seen for other primary outcomes including respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular haemorrhage, periventricular leukomalacia, perinatal death, or mean birthweight. Results for biophysical parameters were inconsistent, but mostly no important differences were seen for these, or any other secondary outcome except for neonatal intensive care unit (NICU) admission. In one trial of 105 infants, significantly more infants in the dexamethasone group were admitted to NICU compared with the betamethasone group (RR 3.83, 95% CI 1.24 to 11.87).Oral dexamethasone compared with intramuscular dexamethasone increased the incidence of neonatal sepsis (RR 8.48, 95% CI 1.11 to 64.93) in one trial of 183 infants. No statistically significant differences were seen for other outcomes reported.In one small trial of 69 infants comparing betamethasone acetate and phosphate with betamethasone phosphate no differences were seen for any of the outcomes reported.

Authors' conclusions: Dexamethasone may have some benefits compared with betamethasone such as less intraventricular haemorrhage, although perhaps a higher rate of NICU admission (seen in only one trial). Apart from a suggestion from another small trial that the intramuscular route may have advantages over an oral route for dexamethasone, few other conclusions about optimal antenatal corticosteroid regimens were able to be made. Trials of commonly used corticosteroids are most urgently needed, followed by trials of dosages and other variations in regimens.

PubMed Disclaimer

References

References to studies included in this review

    1. Chen CY, Wang KG, Chang TY, Chen CP, Loo JH. Effects of antenatal betamethasone and dexamethasone in preterm neonates. Taiwanese Journal of Obstetrics and Gynaecology. 2005;44(3):247–51.
    1. Egerman RS, Mercer B, Doss JL, Sibai BM. A randomized controlled trial of oral and intramuscular dexamethasone in the prevention of neonatal respiratory distress syndrome. American Journal of Obstetrics and Gynecology. 1998;178(1 Pt 2):S19. - PubMed

    2. *

    3. Egerman RS, Mercer BM, Doss JL, Sibai BM. A randomised controlled trial of oral and intramuscular dexamethasone in the prevention of neonatal respiratory distress syndrome. American Journal of Obstetrics and Gynecology. 1998;179(5):1120–3. - PubMed
    4. Egerman RS, Walker RA, Doss JL, Mercer B, Sibai BM, Andersen RN. A comparison between oral and intramuscular dexamethasone in suppressing unconjugated estriol levels during the third trimester. American Journal of Obstetrics and Gynecology. 1998;178(1 Pt 2):S182. - PubMed
    5. Egerman RS, Walker RA, Mercer BM, Doss JL, Sibai BM, Andersen RA. Comparison between oral and intramuscular dexamethasone in suppressing unconjugated estriol levels during the third trimester. American Journal of Obstetrics and Gynecology. 1998;179(5):1234–6. - PubMed

    1. *

    2. Elimian A, Garry D, Figueroa R, Spitzer A, Wiencek V, Quirk JG. Antenatal betamethasone compared with dexamethasone (Betacode Trial): a randomized controlled trial. Obstetrics & Gynecology. 2007;110(1):26–30. - PubMed
    3. Elimian A, Garry D, Figueroa R, Spitzer AR, Wiencek V, Ogburn P, et al. ‘Betacode Trial’ antenatal betamethasone compared to dexamethasone: a randomized controlled trial [abstract] American Journal of Obstetrics and Gynaecology. 2005;193(6 Suppl):S5. - PubMed
    1. Magee LA, Dawes GS, Moulden M, Redman CW. A randomised control comparison of betamethasone with dexamethasone: effects on the antenatal fetal heart rate. British Journal of Obstetrics and Gynaecology. 1997;104(11):1233–8. - PubMed
    1. Mulder EJ, Derks JB, Visser GH. Antenatal corticosteroid therapy and fetal behaviour: a randomised study of the effects of betamethasone and dexamethasone. British Journal of Obstetrics and Gynaecology. 1997;104(11):1239–47. - PubMed

References to studies excluded from this review

    1. Egerman RS, Pierce WF, 4th, Andersen RN, Umstot ES, Carr TL, Sibai BM. A comparison of the bioavailability of oral and intramuscular dexamethasone in women in late pregnancy. Obstetrics & Gynecology. 1997;89(2):276–80. - PubMed
    1. Kurz C, Arbeiter K, Obermair A, Salzer H, Salzer HR, Lohninger A. L-carnitine-betamethasone combination vs betamethasone for prevention of respiratory distress syndrome. Zeitschrift fur Geburtshilfe und Perinatologie. 1993;197:215–9. - PubMed
    1. Liu J, Wang Q, Zhao JH, Chen YH, Qin GL. The combined antenatal corticosteroids and vitamin K therapy for preventing periventricular-intraventricular hemorrhage in premature newborns less than 35 weeks gestation. Journal of Tropical Pediatrics. 2006;52(5):355–9. - PubMed
    1. Romaguera J, Lynch L, Adamson K. The ineffectiveness of dexamethasone to accelerate the progression of L-S ratio. Acta Obstetricia et Gynecologica Scandinavica Supplement. 1997;76(167:1):38.
    1. Salzer H, Husslein P, Binstorfer E, Wagner G, Simbruner G, Popov Ch, Lohninger A. First clinical trial of combination of carnitine and dexamethasone for the induction of lung maturity. Proceedings of 8th European Congress of Perinatal Medicine; Brussels, Belgium. 1982 Sept 7-10; 1982. Abstract no: 198.

Additional references

    1. Abeywandana S. Report of the Australian and New Zealand Neonatal Network 2003. ANZNN; Sydney: 2005.
    1. Rossi S, editor. Australian medicines handbook. AMH; Adelaide: 2006. Anonymous. Corticosteroids; pp. 496–500.
    1. Ballard PL, Ballard RA. Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. American Journal of Obstetrics and Gynecology. 1995;173:254–62. - PubMed
    1. Bar-Lev MR, Maayan-Metzger A, Matok I, Heyman Z, Sivan E, Kuint J. Short term outcomes in low birth weight infants following antenatal exposure to betamethasone versus dexamethasone. Obstetrics & Gynecology. 2004;104(3):484–8. - PubMed
    1. Baud O, Foix-L’Helias L, Kaminski M, Audibert F, Jarreau PH, Papiernik E, et al. Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants. New England Journal of Medicine. 1999;341:1190–6. - PubMed

MeSH terms