Repeat courses of antenatal corticosteroids: The controversy continues

Abstract

confirming the initial findings. 1 Despite what appears to be overwhelming evidence that a single course of antenatal corticosteroids improves outcomes and has a highly favorable risk to benefit ratio, obstetricians throughout the world slowly incorporated the use of corticosteroids into their practice. The reluctance to use corticosteroids was based on the risk of infection, inability to identify the pregnancies that would benefit most, and data from several animal models that suggested that exposure to exogenous corticosteroids resulted in intrauterine growth restriction and permanent damage to the central nervous system. In an attempt to review the scientific evidence and dispel unfounded myths regarding corticosteroids, the National Institutes of Health (NIH) held a consensus conference in 1994. The panel published a consensus statement that strongly supported the use of a single course of corticosteroids in pregnancies between 24 and 34 weeks gestation at risk for delivery within 7 days. 3 They also presented longterm pediatric follow-up data to prove its safety. After the dissemination of the NIH consensus statement, clinical practice appeared to change overnight. Administration of antenatal corticosteroids became the ‘‘standard of care’’ for women at risk for preterm birth and the use of repeat courses of corticosteroids became commonplace. 4 The practice of repeat courses was not