Antenatal steroid administration in medically uncomplicated pregnancy beyond 37 weeks of gestation for the prevention of neonatal morbidities prior to elective caesarean section: a systematic review and meta-analysis of randomised controlled trials

Abstract

Background: Elective caesarean section is associated with an increased risk of respiratory morbidity and admission to special care nursery even at full-term gestation.

Aim: To systematically review the efficacy of antenatal steroid administration to prevent neonatal morbidity at full-term. Only randomised and quasirandomised controlled trials were selected.

Methods: Standardised methodology as described by the Cochrane neonatal review group was used for data collection and analysis.

Results: A total of three randomised controlled trials (N = 2740 patients) were included in the review. Meta-analysis of the published data was carried out. A significant decrease in the risk of respiratory distress syndrome (odds ratio (OR) 0.40 (95%CI: 0.23-0.71, p < 0.001), risk of transient tachypnoea of newborn (OR 0.37 (95%CI: 0.25-0.56, p < 0.00001)), risk of admission to special care nursery (OR 0.53 (95%CI: 0.37-0.76, p < 0.0007)) were observed.

Conclusion: Although antenatal steroid administration prior to elective caesarean section demonstrated significant benefit in the prevention of neonatal morbidities; however, one need to be cautious before it can be routinely administered because of the paucity of long-term safety data.

Keywords: Antenatal steroids; elective caesarean section; perinatal mortality; respiratory distress; transient tachypnoea of newborn.