Multiple courses of antenatal corticosteroids: A systematic review and meta-analysis

OBJECTIVE: To assess the effects of multiple courses of antenatal corticost eroids on perinatal and neonatal death and neonatal, infant, and maternal d isease, METHODS: MEDLINE and Embase were searched for human studies published in En glish. Studies that compared multiple courses of antenatal corticosteroids versus a single course were included if they were published in full and wer e controlled for gestational age at birth, Meta-analyses (odds ratio and 95 % confidence interval) were undertaken when possible. RESULTS: Eight observational studies were Included. Selection bias was pres ent In all studies. Multiple courses of antenatal corticosteroids were asso ciated with a decreased risk of respiratory distress syndrome (odds ratio, 0.79; 95% confidence Interval, 0.64 to 0.98) and patent ductus arteriosus ( odds ratio, 0.56; 95% confidence interval, 0.35 to 0.90) and were associate d with an increased risk of endometritis (odds ratio, 3.42; 95% confidence interval, 1.92 to 6.11). There was no significant effect on other neonatal and maternal outcomes. CONCLUSION: It is not possible to establish the true effects of multiple co urses of antenatal corticosteroids by a review of the results of observatio nal studies because of the effect of confounding variables. Randomized cont rolled trials are needed to address this Important issue.