Repeat courses of antenatal corticosteroids are not clinically warranted

המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-10 18:01:04 EDT (Reuters Health)

The following are quotes from Dr. Larry Gilstrap:

"The consensus panel reaffirmed that a single course of antenatal
corticosteroids decreased morbidity in the newborn at gestational ages of 24
to 34 weeks. This consensus conference in August, 2000 reaffirmed the NIH
consensus conference in 1994."

"They also concluded that the current risk and benefit data are insufficient
to support repeat courses of steroids."

"Repeat or rescue doses of antenatal corticosteroids should only be utilized
in randomized clinical trials."*********************************

WESTPORT, CT (Reuters Health) – While a single course of antenatal corticosteroids is useful and efficacious for pregnant women at risk of preterm delivery, there are insufficient benefit and risk data to support the use of repeat courses of corticosteroids, according to a report in the July issue of Obstetrics and Gynecology.

In 1994, a consensus panel sponsored by the National Institutes of Health concluded that "giving a single course of corticosteroids to pregnant women at risk for preterm delivery reduces the risk of death, respiratory distress syndrome, and intraventricular hemorrhage in their preterm infants."

Last year, the NIH organized a conference to examine research on repeat courses of antenatal corticosteroid treatment. An independent, non-Federal consensus development panel, led by Dr. Larry C. Gilstrap III, of the University of Texas-Houston Medical School, answered "predefined questions" and "developed their conclusions based on the scientific evidence presented in open forum and the scientific literature."

Data from trials of repeat courses of antenatal corticosteroids, "suggested possible benefits in reduction of the incidence and severity of respiratory distress syndrome, and reduction in the incidence of patient ductus arteriosus." However, they found no evidence to support other benefits.

The investigators explain that while the evidence of short- and long-term adverse effects of repeat doses of corticosteroids is contradictory and inconclusive, "some studies suggest matters of concern."

They therefore conclude that "data from currently available studies assessing benefits and risks are inadequate to argue for or against the use of repeat or rescue courses of antenatal corticosteroids for fetal maturation."

The team currently recommends that "all pregnant women between 24 and 34 weeks' gestation who are at risk of preterm delivery within 7 days should be considered candidates for antenatal treatment with a single course of corticosteroids." In accordance with the 1994 recommendations, the treatment should consist of 12 mg betamethasone given IM 24 hours apart or four doses of 6 mg dexamethasone given IM 12 hours apart.

"Clinical trials are in progress to assess potential benefits and risks of various regimens of repeat courses," Dr. Gilstrap and colleagues add. "Until data establish a favorable benefit-to-risk ratio, repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials."

Obstet Gynecol 2001;98:144-150.

-Westport Newsroom 203 319 2700

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