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Article by Specialist Doctor II Nguyen Thu Hoai - Obstetrician and Gynecologist - Women's Health Center - Vinmec Times City International Hospital
Pregnant women at risk of premature birth are often prescribed corticosteroid injections to support fetal lung maturation. Besides the benefit of reducing the risk of respiratory failure in the neonate, lung maturation injection also has some undesirable side effects. Therefore, pregnant women need to know some new recommendations about corticosteroid injections to support the lungs for premature births to consider and make the right decision.
The first trial of prenatal corticosteroids to reduce respiratory distress syndrome in premature infants was published in 1972. Then from the mid-1980s to the present, the use of prenatal corticosteroids has been increasingly used. . From the strong evidence for their effectiveness in this regard, all the World Health Organizations now endorse their use to improve outcomes for premature infants. In singleton pregnancies with an increased risk of preterm birth before 34 weeks, studies have shown that the use of corticosteroids (betamethasone, dexamethasone, or hydrocortisone) clearly shows benefits for the baby such as reducing perinatal mortality, reducing distress syndrome. respiratory, reduce intraventricular hemorrhage, reduce necrotizing enterocolitis. Potential adverse effects, such as decreased glucose tolerance, may be observed in infants exposed to corticosteroids before birth in utero. The benefits of antenatal steroid use were strongest for infants born between 24 and 34 weeks of gestation, with the benefit of corticosteroids being less potent when administered after 35 weeks.
For women with multiples who are at risk for preterm birth between 24 and 34 weeks, obstetricians also recommend prenatal corticosteroids to improve outcomes for the baby.
With a pregnancy predicting preterm birth between 34 weeks and 37 weeks of age, a high-quality US study that evaluated the effects of corticosteroids in 2831 women found that corticosteroid use significantly reduced Statistical analysis of neonatal respiratory support needs during the first 72 hours of life, however, neonatal hypoglycemia is more common. Although no long-term harm has been demonstrated following corticosteroid use in preterm pregnancy, there are no significant follow-up trials. Observational studies using population data suggest that prenatal corticosteroid exposure is associated with increased diagnoses of behavioral and psychiatric disorders in children. Therefore, the International Association of Obstetricians and Gynecologists recommends: Routine prenatal corticosteroids should not be used in women with anticipated late preterm birth. Instead, the use of prenatal corticosteroids should be weighed against the balance of risks and benefits for the individual woman.
Previously, the regimen for corticosteroid injections for lung maturation drugs differed between betamethasone or dexamethasone drugs. However, recently, based on many studies on the effectiveness of drugs, it has been shown that with the regimen of 2 injections, 24 hours apart, the drugs are equally effective, as well as the side effects. similar.
There are no large randomized follow-up trials comparing infants born after different injection intervals. Retrospective studies have suggested that mortality and morbidity are lowest at birth 18–36 hours after steroid administration, although some benefit may be seen if delivered within 3 hours after injection. The risk of severe traumatic brain injury was most significantly reduced at birth within 48–72 hours of steroid injection. Almost all of the benefits of prenatal steroid use disappear, if delivery occurs 1 week after taking the steroid. Therefore, it is recommended that corticosteroids be administered before delivery, ideally 18-72 hours, and certainly not more than 1 week before expected preterm delivery. However, if premature delivery is expected within 18 hours, prenatal corticosteroids should still be given.
Animal studies have shown an adverse effect of multiple courses of prenatal corticosteroids on the baby's birth weight and hypothalamic-pituitary-adrenal axis function and neuromyelination. menstruation afterwards. However, in women who are still at risk of preterm birth 7 days or more after the first course of treatment, a repeat course of corticosteroids reduces the risk of respiratory distress syndrome and severe neonatal outcomes. Follow-up in childhood (18–24 months) had no impact on children (including mortality, disability-free survival, rate of serious outcomes, or growth retardation). No significant positive or negative effects were apparent on the mother. The International Association of Obstetricians and Gynecologists recommends that an additional course of prenatal corticosteroids may be given to improve baby outcomes in women who are expected to deliver prematurely within 72 hours and have received a course of corticosteroids more than one year apart. weeks,
In cases of elective cesarean section with term pregnancy (gestational age ≥39 weeks), corticosteroid injection before cesarean section is not recommended as no apparent benefit to the neonate has been observed.
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