scholarly journals Antenatal steroids for fetal lung maturity: Time to target more frequent doses to fewer women?

2015 ◽  
Vol 8 (4) ◽  
pp. 172-176 ◽  
Author(s):  
Carolyn I Freeman ◽  
Natasha L Hezelgrave ◽  
Andrew H Shennan
Keyword(s):  
High Risk ◽  
Day Treatment ◽  
Fetal Lung ◽  
Optimal Timing ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Targeting Therapy ◽  
Antenatal Steroids ◽  
Maximum Benefit ◽  
Fetal Lung Maturation

Antenatal corticosteroids for fetal lung maturation have become mainstay treatment in women thought to be at high-risk of premature birth. To ensure treatment efficacy before delivery, the current practice is to administer steroids early to a woman considered at risk; however, neonatal benefit is lost after the seven-day treatment-to-delivery window. Over half of women who deliver before 34 weeks’ gestation do not receive antenatal corticosteroids within this timeframe, but many still deliver prematurely; however, clinicians are reluctant to administer repeated courses of steroids due to concerns, among others, of impaired fetal growth. However, evidence is mounting regarding the optimal timing for steroids, including substantive benefits close to delivery, and the benefits of repeated courses if delivery has not occurred. Better targeted treatment is required to allow for maximum benefit; reducing unnecessary treatment in low-risk women, while targeting therapy in the high-risk cohort and offering repeat courses if the seven-day window is exceeded. Novel tools to aid prediction may help implement this strategy.

SARS-CoV-2: do corticosteroids for fetal lung maturation worsen maternal or fetal outcomes?

2021 ◽  
Vol 29 (2) ◽  
pp. 90-92
Author(s):  
Nashwa Eltaweel ◽  
Samuel Lockley ◽  
Irshad Ahmed ◽  
Bee K Tan
Keyword(s):  
Case Studies ◽  
Clinical Case ◽  
Intraventricular Haemorrhage ◽  
Fetal Lung ◽  
Premature Delivery ◽  
Lung Maturation ◽  
Antenatal Steroids ◽  
Clinical Case Studies ◽  
Inflammatory Processes ◽  
Fetal Lung Maturation

Immune system changes during pregnancy could make pregnant women more susceptible to SARS-Cov-2 infection. The use of corticosteroids within obstetrics has been shown to reduce the risks of respiratory distress syndrome, intraventricular haemorrhage, necrotizing enterocolitis and neonatal death in the baby associated with premature delivery. During the COVID-19 pandemic, corticosteroids have been trialled as a treatment to dampen the ‘cytokine storm’ and associated inflammatory processes. Corticosteroids have long been known to have immunosuppressive effects that could hinder the body's ability to mount a defence against COVID-19 and thereby delaying viral clearance. In this clinical case studies, antenatal steroids for fetal lung maturation appear to be of benefit and did not result in a deterioration of maternal disease. Our clinical case studies support the current recommendations from the Royal College of Obstetricians and Gynaecologists ie corticosteroids for fetal lung maturation is appropriate in patients who are suspected or have confirmed SARS-CoV-2 infection.

scholarly journals Histochemical Analyses of Altered Fetal Lung Development Following Single vs Multiple Courses of Antenatal Steroids

2005 ◽  
Vol 53 (12) ◽  
pp. 1469-1479 ◽  
Author(s):  
Zarah J. Pua ◽  
Barbara S. Stonestreet ◽  
Anne Cullen ◽  
Aliakbar Shahsafaei ◽  
Grazyna B. Sadowska ◽  
...  
Keyword(s):  
Cell Injury ◽  
Smooth Muscle Actin ◽  
Fetal Lung ◽  
Nuclear Antigen ◽  
Lung Maturation ◽  
Injury Death ◽  
Fetal Lung Development ◽  
Antenatal Steroids ◽  
Lung Histopathology ◽  
Fetal Lung Maturation

A single course of antenatal steroids is widely used during preterm labor to promote fetal lung maturation. However, little is known regarding efficacy and safety of multiple courses of antenatal steroids. In animal models and clinical trials, treatment with glucocorticoids can inhibit growth. The present study of single- vs multiple-course steroids in pregnant ewes analyzes the effects of steroids vs placebo on fetal lung histopathology. Single-course groups received dexamethasone (Dex) 6 mg or normal saline every 12 hr for 48 hr at 104-106 days of gestation (term = 150 days). Multiple-course groups received the first course at 76-78 days; this was repeated weekly for 5 weeks. At 108 days, lungs were analyzed using immunohistochemistry for α-smooth muscle actin, a myofibroblast marker and proliferating cell nuclear antigen. Cell injury/death was evaluated using TdT-mediated dUTP digoxigenin nick end labeling (TUNEL) analysis. Although fetal growth was restricted by either single or multiple courses of Dex, alveolar development was accelerated as measured by mean linear intercepts. Alveolar walls were thinner, developing septa were longer, and septal myofibroblasts were increased for both Dex groups compared with controls. Cell proliferation increased following multiple steroid courses, especially in the distal parenchyma, with a corresponding decrease in apoptosis. These observations suggest that Dex promotes alveolarization, whether given in single or multiple courses.

The Effect of Antenatal Steroids on Fetal Lung Maturation between the 34th and 36th Week of Pregnancy

2010 ◽  
Vol 70 (2) ◽  
pp. 95-99 ◽  
Author(s):  
Osman Balci ◽  
Suna Ozdemir ◽  
Alaa S. Mahmoud ◽  
Ali Acar ◽  
Mehmet C. Colakoglu
Keyword(s):  
Fetal Lung ◽  
Lung Maturation ◽  
Antenatal Steroids ◽  
Fetal Lung Maturation

Efficacy and Safety of Corticosteroids’ Administration for Pulmonary Immaturity in Anticipated Preterm Delivery

2020 ◽  
Vol 26 ◽  
Author(s):  
Themistoklis Dagklis ◽  
Ioannis Tsakiridis ◽  
Georgios Papazisis ◽  
Apostolos Athanasiadis
Keyword(s):  
Preterm Delivery ◽  
Neonatal Morbidity ◽  
Fetal Lung ◽  
Respiratory Morbidity ◽  
Efficacy And Safety ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Early Neonatal Mortality ◽  
Elective Cesarean ◽  
Fetal Lung Maturation

: Preterm delivery represents the major cause of neonatal morbidity and mortality. Respiratory morbidity is the primary cause of early neonatal mortality and disability. The administration of antenatal corticosteroids, in cases of imminent preterm delivery, can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes. Hence, for those cases, a single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered. Betamethasone and dexamethasone are the most widely used drugs, with similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24-hour period. However, there is an ongoing debate regarding the gestational age of administration. Some obstetric societies recommend their administration even at 22 weeks of gestation. Conflicting is also their usefulness in late preterm cases (between 34 and 37 weeks) or in cases of elective cesarean delivery at term. The use of repeated courses of corticosteroids may be considered in specific cases, however, concerns on the long-term outcomes of repeated courses beyond 34 gestational weeks have been raised. The scope of this narrative review was to synthesize available evidence on efficacy and safety of corticosteroids administration during the antenatal period for pulmonary immaturity in cases of anticipated preterm delivery.

scholarly journals Antenatal corticosteroids: a reappraisal of the drug formulation and dose

2020 ◽  
Author(s):  
Alan H. Jobe ◽  
Matthew Kemp ◽  
Augusto Schmidt ◽  
Tsukasa Takahashi ◽  
John Newnham ◽  
...  
Keyword(s):  
Perinatal Care ◽  
Fetal Lung ◽  
The United States ◽  
Drug Formulation ◽  
List Type ◽  
Continuous Exposure ◽  
Fetal Exposure ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Fetal Lung Maturation

Abstract We review the history of antenatal corticosteroid therapy (ACS) and present recent experimental data to demonstrate that this, one of the pillars of perinatal care, has been inadequately evaluated to minimize fetal exposure to these powerful medications. There have been concerns since 1972 that fetal exposures to ACS convey risk. However, this developmental modulator, with its multiple widespread biologic effects, has not been evaluated for drug choice, dose, or duration of treatment, despite over 30 randomized trials. The treatment used in the United States is two intramuscular doses of a mixture of 6 mg betamethasone phosphate (Beta P) and 6 mg betamethasone acetate (Beta Ac). To optimize outcomes with ACS, the goal should be to minimize fetal drug exposure. We have determined that the minimum exposure needed for fetal lung maturation in sheep, monkeys, and humans (based on published cord blood corticosteroid concentrations) is about 1 ng/ml for a 48-h continuous exposure, far lower than the concentration reached by the current dosing. Because the slowly released Beta Ac results in prolonged fetal exposure, a drug containing Beta Ac is not ideal for ACS use. Impact Using sheep and monkey models, we have defined the minimum corticosteroid exposure for a fetal lung maturation. These results should generate new clinical trials of antenatal corticosteroids (ACS) at much lower fetal exposures to ACS, possibly given orally, with fewer risks for the fetus.

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