Maternal infectious morbidity following multiple courses of betamethasone

Objective: the beneficial effects of antepartum corticosteroids on the redu ction of morbidity and mortality in the premature neonate have been amply d emonstrated. The NIH consensus statement has, therefore, endorsed their use in women at risk from pre-term delivery between 24 and 34 weeks gestation. Patients at persistent risk of pre-term delivery may receive multiple week ly courses. However, increased susceptibility to infection is a well-recogn ized complication of prolonged high-dose steroid therapy We examined infect ious morbidity among women exposed to three or more courses of betamethason e. Methods and outcome measures: thirty-seven patients at risk of pre-term del ivery who received three or more courses of betamethasone (median = 6; rang e 3-10) and 74 normal controls, matched for maternal age, route of delivery , and year of delivery were included in the study. Data on medical care pro vided to study and control patients between 24 weeks gestation and 6 weeks postpartum were retrieved from centralized medical records. Incidences and types of infections were compared by Chi-square and Fisher's exact test, as appropriate. Only infections diagnosed at least 1 week after betamethasone therapy was initiated were included. Patients with pre-existing conditions predisposing to infectious morbidity were excluded. Results: twenty-four of 37 patients (64.8%) exposed to betamethasone vs. 13 of 74 (17.5%) controls developed infectious diseases (P < 0.001). Symptoma tic lower urinary tract infections occurred in 13 of 37 (35.1%) and two of 74 (2.7%) in the study and control groups, respectively (P < 0.001), Seriou s bacterial infections were found in nine of 37 (24.3%,) vs. none of 74 (0% ) patients, respectively (P < 0.001). These included sepsis (n = 2), pneumo nia (n = 4), pyelonephritis (n = 2), and cholangitis (n = 1). Fight of nine serious infections occurred in patients exposed to five or more weekly cou rses of betamethasone. Postpartum endometritis related to Caesarean deliver y was found in five of 37 patients (13.5%) vs. seven of 74 (9.4%), respecti vely (P = NS). Conclusions: Three or more courses of antepartum betamethasone in women at risk of pre-term delivery are associated with substantial infectious matern al morbidity. The excess morbidity consisted mainly of bacterial infections , some of which were associated with systemic and potentially life-threaten ing infections.