Antenatal steroid treatment and adverse fetal effects: What is the evidence?

This article reviews current animal and human data regarding possible adver se fetal effects from antenatal steroid treatment. Although it is now well accepted that such treatment is of benefit to fetal lung development, the p otential for adverse fetal outcomes as a result of single or multiple gluco corticoid dosing has not been widely recognized. There ave now growing conc erns, based oil animal and some human data, that repeated antenatal doses c ould lead to a decrease in birth weight, a decrease in fetal brain and othe r organ size, and abnormal neuronal development. Previous investigations ha ve been hampered by nonstandardization in the type of glucocorticoid, route of delivery, timing of administration, and number of treatment courses. It is recommended that these concerns be addressed through large randomized, controlled clinical trials. In the meantime, it would be prudent to minimiz e antenatal steroid treatments to a single course with repeated dosing only if there is a persistent threat of preterm delivery. The practice of givin g weekly injections of steroids starting at fetal viability and continuing into the third trimester is not supported. Copyright (C) 2000 by the Societ y for Gynecologic Investigation.