Multiple courses of antenatal corticosteroids and outcome of premature neonates. North American Thyrotropin-Releasing Hormone Study Group

Am J Obstet Gynecol. 1999 Sep;181(3):709-17. doi: 10.1016/s0002-9378(99)70517-x.


Objectives: We sought to examine outcome for premature neonates after multiple courses of antenatal corticosteroids compared with a single course.

Study design: We performed a post hoc nonrandomized analysis on 710 neonates of 25-32 weeks' gestation who were born to mothers enrolled in the North American Thyrotropin-Releasing Hormone Trial and who received 1, 2, or >/=3 courses of antenatal corticosteroids.

Results: There was no detectable clinical difference in incidence of respiratory distress syndrome, chronic lung disease, and intraventricular hemorrhage related to courses of antenatal corticosteroids, and outcome was similar for infants delivered at 7-13 days compared with those delivered at 1-6 days after receiving antenatal corticosteroids. Compared with those who received a single course, neonates who received >/=2 courses had lower birth weights (-39 g, P =.02), and those receiving >/=3 courses had increased risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.3-5.9; P =.01) and lower levels of plasma cortisol at age 2 hours.

Conclusion: In this retrospective analysis multiple courses of antenatal corticosteroids did not improve outcome and were associated with increased mortality, decreased fetal growth, and prolonged adrenal suppression.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenal Insufficiency / chemically induced
  • Female
  • Gestational Age
  • Humans
  • Hydrocortisone / blood
  • Infant Mortality
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature*
  • Lung Diseases / prevention & control*
  • Obstetric Labor, Premature*
  • Odds Ratio
  • Pregnancy
  • Retrospective Studies
  • Treatment Outcome*


  • Adrenal Cortex Hormones
  • Hydrocortisone