Technical Update No. 439: Antenatal Corticosteroids at Late Preterm Gestation

Abstract

Objective: To update recommendations for administration of antenatal corticosteroids in the late preterm period.

Target population: Pregnant individuals at risk of preterm birth from 34⁰ to 36⁶ weeks gestation.

Options: Administration or non-administration of a single course of antenatal corticosteroids at 34⁰ to 36⁶ weeks gestation.

Outcomes: Neonatal morbidity (respiratory distress, hypoglycemia), long-term neurodevelopment, and other long-term outcomes (growth, cardiac/metabolic, respiratory).

Benefits, harms, and costs: Administration of antenatal corticosteroids from 34⁰ to 36⁶ weeks gestation decreases the risk of neonatal respiratory distress but increases the risk of neonatal hypoglycemia. The long-term impacts of antenatal corticosteroid administration from 34⁰ to 36⁶ weeks gestation are uncertain.

Evidence: For evidence on the neonatal effects of antenatal corticosteroid administration at late preterm gestation, we summarized evidence from the 2020 Cochrane review of antenatal corticosteroids and combined this with evidence from published randomized trials identified by searching Ovid MEDLINE from January 1, 2020, to May 11, 2022. Given the absence of direct evidence on the impact of late preterm antenatal corticosteroid administration on neurodevelopmental outcomes, we summarized evidence on the impact of antenatal corticosteroids across gestational ages on neurodevelopmental outcomes using the following sources: (1) the 2020 Cochrane review; and (2) evidence obtained by searching Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to January 5, 2022. We did not apply date or language restrictions. Given the absence of direct evidence on the impact of late preterm antenatal corticosteroid administration on other long-term outcomes, we summarized evidence on the impact of antenatal corticosteroids across gestational ages on other long-term outcomes by combining findings from the 2020 Cochrane review with evidence obtained by searching Ovid MEDLINE for observational studies related to long-term cardiometabolic, respiratory, and growth effects of antenatal corticosteroids from inception to October 22, 2021. We reviewed reference lists of included studies and relevant systematic reviews for additional references. See Appendix A for search terms and summaries.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix B (Tables B1 for definitions and B2 for interpretations of strong and conditional [weak] recommendations).

Intended audience: Maternity care providers, including midwives, family physicians, and obstetricians.

Summary statements: RECOMMENDATIONS.

Keywords: adrenal cortex hormones; corticosteroids; pregnancy; preterm birth.