26: Antenatal Steroids - Part 2

In this episode Dr. Øystein Bergøy discusses the evidence behind the risks of antenatal corticosteroids for women at risk for preterm delivery.    [email protected]   ACOG guidelines on fetal maturation  NICE guidelines on risk of premature labour  Norwegian guidelines on risk of premature labour  2015 cochrane analysis of repeat steroids  Study were microsimulation was used to make a ratio of benefits vs harms of repeat steroids according to gestational age at birth  Uptodate.com article on antenatal steroids  study showing increased rds 1 to 24 hrs after booster dose Review from Nature in 2001 mentioning several animall studies that show negative effects of excess corticosteroids in utero Animal study from Kidney Int from 2000 showing increased risk of glucose intolerance with exogenous corticosteroid exposure in utero  Study in baboons from Nature in 2012 showing impaired myelination after exposure to repeat antenatal steroids  3 studies that have shown impaired stress response inneonates exposed to antenatal steroids https://www.ncbi.nlm.nih.gov/pubmed/?term=Antenatal+betamethasone+administration+alters+stress+physiology+in+healthy+neonates https://www.ncbi.nlm.nih.gov/pubmed/?term=Effects+of+prenatal+betamethasone+exposure+on+regulation+of+stress+physiology+in+healthy+premature+infants https://www.ncbi.nlm.nih.gov/pubmed/?term=Neonatal+adrenal+function+after+repeat+dose+prenatal+corticosteroids%3A+a+randomized+controlled+trial https://www.ncbi.nlm.nih.gov/pubmed/?term=Multiple+courses+of+antenatal+corticosteroids+and+outcome+of+premature+neonates.+North+American+Thyrotropin-Releasing+Hormone+Study+Group Study showing impaired HPA function in children 6-11 years of age exposed to antenatal steroids  Study showing signs of glucose intolerance in participant who received antenatal steroids compared to placebo Study showing increased aortic stiffness in those exposed to antenatal steroids crowther et al mid childhood neurocgognitive development  meta analysis from 2016 in BMJ examining benefits and harms of antenatal steroids between 34 and 36 weeks gestation