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Abstract

To the Editors:We sincerely appreciate Cale and Bird’s clarification of the mechanisms of secondary adrenal insufficiency related to exogenous steroids. Their comments underscore the importance of collaboration between basic scientists and clinicians in maternal-fetal medicine. The suggestion that chronic antenatal exposure to high doses of glucocorticoids may result in adverse fetal cellular programming is particularly worrisome. This issue must be systematically studied, because the full extent of these potential effects may not be apparent for many years.The use of repeated courses of antenatal corticosteroids became routine for many obstetricians after the 1994 National Institutes of Health Consensus Development Conference, despite the lack of evidence attesting to the efficacy and safety of this practice. We applaud the National Institutes of Health’s second consensus statement on antenatal steroids and their recommendation that “repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials.”1Antenatal corticosteroids revisited: repeat courses NIH Consensus Statement Online [serial online]. 2000 Aug 17-18; 17 ([cited 2001 Jan 19] Available from: URL:): 1-10http://odp.od.nih.gov/consensus/cons/112/112_intro.htmGoogle Scholar6/8/114488 To the Editors:We sincerely appreciate Cale and Bird’s clarification of the mechanisms of secondary adrenal insufficiency related to exogenous steroids. Their comments underscore the importance of collaboration between basic scientists and clinicians in maternal-fetal medicine. The suggestion that chronic antenatal exposure to high doses of glucocorticoids may result in adverse fetal cellular programming is particularly worrisome. This issue must be systematically studied, because the full extent of these potential effects may not be apparent for many years.The use of repeated courses of antenatal corticosteroids became routine for many obstetricians after the 1994 National Institutes of Health Consensus Development Conference, despite the lack of evidence attesting to the efficacy and safety of this practice. We applaud the National Institutes of Health’s second consensus statement on antenatal steroids and their recommendation that “repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials.”1Antenatal corticosteroids revisited: repeat courses NIH Consensus Statement Online [serial online]. 2000 Aug 17-18; 17 ([cited 2001 Jan 19] Available from: URL:): 1-10http://odp.od.nih.gov/consensus/cons/112/112_intro.htmGoogle Scholar6/8/114488 We sincerely appreciate Cale and Bird’s clarification of the mechanisms of secondary adrenal insufficiency related to exogenous steroids. Their comments underscore the importance of collaboration between basic scientists and clinicians in maternal-fetal medicine. The suggestion that chronic antenatal exposure to high doses of glucocorticoids may result in adverse fetal cellular programming is particularly worrisome. This issue must be systematically studied, because the full extent of these potential effects may not be apparent for many years. The use of repeated courses of antenatal corticosteroids became routine for many obstetricians after the 1994 National Institutes of Health Consensus Development Conference, despite the lack of evidence attesting to the efficacy and safety of this practice. We applaud the National Institutes of Health’s second consensus statement on antenatal steroids and their recommendation that “repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials.”1Antenatal corticosteroids revisited: repeat courses NIH Consensus Statement Online [serial online]. 2000 Aug 17-18; 17 ([cited 2001 Jan 19] Available from: URL:): 1-10http://odp.od.nih.gov/consensus/cons/112/112_intro.htmGoogle Scholar 6/8/114488