|Repeat Corticosteroids in Pregnancy Cuts Preemie Illness|
Study shows a benefit, but experts remain cautious
By Steven Reinberg
FRIDAY, June 9 (HealthDay News) -- Giving repeat doses of corticosteroids to expectant moms at risk for preterm delivery may reduce the chances of illness in their newborns, a new report suggests.
"Short-term benefits for the babies in our study support the use of repeat doses of corticosteroids in women who remain at risk of very preterm birth seven or more days after an initial course [of the drugs]," the Australian authors concluded in the June 10 issue of The Lancet.
Babies born prematurely run the risk of developing lung disease and respiratory distress syndrome. Currently, mothers who are at risk of preterm delivery are given a single dose of corticosteroids to help reduce the risk of their child developing these conditions.
Earlier studies have shown that repeating the doses of corticosteroids appears to be beneficial. However, other studies have found adverse side effects, including growth problems, infection after birth, and abnormal development in childhood among children whose mothers received several doses of corticosteroids.
In the current study, Dr. Caroline Crowther from the Women's and Children's Hospital, North Adelaide, and colleagues looked at 982 pregnant women at risk of preterm birth. All the women were less than 32 weeks pregnant and had received a single dose of corticosteroids.
Crowther's team randomly assigned the women to a repeat injection of corticosteroids or placebo every week until they were 32 weeks pregnant. The researchers then went on to track the health of babies born to these women, until they left the hospital.
Thirty-three percent of infants whose mothers had received repeat doses of corticosteroids developed respiratory distress syndrome, compared with 41 percent of the infants whose mothers had gotten just a single dose, the researchers found.
In addition, 12 percent of the infants in the multi-dose group developed severe lung disease, compared with 20 percent in the single-dose group. Moreover, infants exposed to multiple doses of corticosteroids needed less oxygen therapy and less help breathing, compared with those exposed to a single dose, the researchers reported.
One expert agreed that several doses of corticosteroids may be warranted but cautioned that more trials with longer-term follow-up are needed before this can become common practice.
"There is concern about negative effects of corticosteroids on the fetal brain, growth, neurological development and insulin resistance," said Dr. Sven Montan, from the Department of Obstetrics and Gynecology at Malmo University Hospital, Sweden. He authored an accompanying editorial on the subject.
"This randomized controlled study is an important contribution to our present knowledge on short-term effects of repeated antenatal corticosteroids," he added.
"Better short-term neonatal health can be achieved if repeated doses of corticosteroids are given to women at risk of preterm birth," Montan said. "However, multiple courses of corticosteroids should be used with caution until results from long term follow-up studies are known."
Another expert agreed that longer follow-up is needed to determine if children who are exposed to multiple doses of corticosteroids have developmental problems.
"There has always been a controversy about giving multiple doses of corticosteroids," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "You do want to optimize the lungs, but there is fear that you will cause developmental damage," she said.
Because of this, doctors have been reluctant to adopt the multi-dose regimen, Wu said. "We need further studies and long-term follow-up," she said. "You really have to follow these kids until they are five or six years old to see if there are any developmental problems," she said.
For more on respiratory distress syndrome, head to the American Lung Association.
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SOURCES: Sven Montan, M.D., Department of Obstetrics and Gynecology, Malmo University Hospital, Malmo, Sweden; Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; June 10, 2006, The Lancet