Antenatal glucocorticoids in prematurity - Weighing the risks and benefitsin evidence-based medicine

Prematurity is a major cause of perinatal morbidity and mortality. Antenata l administration of glucocorticoids improves the neonatal outcome of preter m born infants. 1994 the NIH published recommendations for the use of gluco corticoids for women at risk of preterm delivery. A recent evaluation by th e Cochrane Collaboration in 1999 showed that antenatal administration of gl ucocorticoids significantly reduced the rate of RDS and IVH in the gestatio nal age between 24 and 34 weeks. Consequences of repeated courses of antena tal glucocorticoids are not sufficiently studied. The effectivity and safet y regarding birth weights, infectious diseases, and the best timing remains unknown. Administration of glucocorticoids lowers fetal activity and heart rate variability. Effects on fetal growth, maternal and fetal immunosystem , and the development of atopic diseases are controversely discussed. Thus preterm labour not leading to a cervical ripening is not necessarily a reas on for antenatal glucocorticoids. Antenatal glucocorticoids with FROM do no t lower the rate of RDS but of IVH. No prospective randomized trial evaluat ed the effectivity of antenatal glucocorticoids in diabetes mellitus and IU GR. In preeclampsia beta-methason could improve the rate of RDS and the neo natal outcome. Still our knowledge of antenatal glucocorticoid administrati on is not sufficient. But despite possible (longtime-) risks for mother and child the administration of glucocorticoids according to the guidelines of the NIH is a major part in the treatment of prematurity and improves the o utcome of premature infants. The indication for multiple courses of glucoco rticoids should be considered carefully.