American
College of Obstetricians and Gynecologists (ACOG) recently updated its committee opinion for administration of prenatal corticosteroids and expanded it to high risk
women for late preterm birth (34 0/7 - 36 6/7 weeks).
“Providing
women’s health care providers with evidence-based techniques to successfully
manage instances of preterm birth is a top priority for ACOG,” said one of the
Committee Opinion authors,
Dr. Yasser El-Sayed, MD, FACOG. “Through the new
committee opinion we are expanding an existing therapy, based on recent data,
to improve outcomes in more clinical settings. It’s an important step in
getting more mothers and babies the care they need to be healthy.”[1]
This new
Committee Opinion replaces ACOG’s Practice Advisory on Antenatal Corticosteroid
Administration in the Late Preterm Period, originally issued on April 4, 2016.[2]
These
recommendations follow the results of significant Antenatal Late PretermSteroids (ALPS) trial, published earlier this year.[3] The
committee opinion now includes recommendations that support the administration
of antenatal corticosteroids in certain populations during the late preterm
birth period, or between 34 and 37 weeks of gestation.
The recommendation
also holds good in multiple gestation.
Corticosteroids
given late preterm significantly reduced the rate of neonatal respiratory
complications like transient tachypnea of the newborn, surfactant use, and
bronchopulmonary dysplasia. Studies also show lower rates of intracranial hemorrhage,
necrotizing enterocolitis, and mortality. The only side effect is neonatal
hypoglycemia which should be monitored closely.
As per the
news release “The document also re-emphasizes ACOG’s recommendation to consider
antenatal corticosteroids for pregnant women at risk of preterm delivery
starting at 23 weeks of gestation, based on a family’s decision regarding
resuscitation.”
The ACOG recommendations
in the October issue of journal of Obstetrics and Gynecology[4]: It states:
- A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation, including for those with ruptured membranes and multiple gestations. It may be considered for women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family’s decision regarding resuscitation.
- A single course of betamethasone is recommended for pregnant women between 34 0/7 weeks and 36 6/7 weeks of gestation at risk of preterm birth within 7 days, and who have not received a previous course of antenatal corticosteroids.
- Treatment should consist of either two 12-mg doses of betamethasone given intramuscularly 24 hours apart or four 6-mg doses of dexamethasone administered intramuscularly every 12 hours.
- Scheduled repeat course or serial courses are not recommended.
- A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who have an imminent risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario.
- Evidence is insufficient at present for giving a rescue or repeat course in patients with preterm pre labor rupture of membranes (PROM), hence no recommendation is made.
- ACOG advocates continuous long term monitoring of patients who received corticosteroids.
[1]http://www.acog.org/About-ACOG/News-Room/News-Releases/2016/ACOG-Improves-Outcomes-for-Preterm-Births
[2] http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Antenatal-Corticosteroid-Administration-in-the-Late-Preterm-Period
[3] http://www.nejm.org/doi/full/10.1056/NEJMoa1516783#t=article
[4] http://journals.lww.com/greenjournal/Fulltext/2016/10000/Committee_Opinion_No_677___Antenatal.62.aspx
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