Multiple courses of antenatal glucocorticoid treatment and fetal outcome

Thanks to the US National Institutes of Health Consensus Conference, the od ds of antenatal use of glucocorticoids for preventing severe neonatal compl ications of premature delivery have significantly increased these last year s. The belief that neonatal benefits last up to 7 days after the first cour se and administration of further courses is safe has led many obstetricians to prescribe multiple antenatal glucocorticoid courses. Whether multiple c ourses offer an advantage over a single course has not been demonstrated. I n contrast, there are accumulating evidence suggesting that this practice m ay have short and long-term side effects. The potential benefits and side e ffects of multiple antenatal courses of glucocorticoids, extrapolated from experimental data and observational studies, are detailed in this review. U ntil the results of ongoing randomized trials with long term follow-up are available, the practice of giving multiple courses of glucocorticoids to wo men should be considered with the greatest caution.