Maternal Epidural Steroids to Prevent Neonatal Exposure to Hyperthermia and Inflammation

Am J Perinatol. 2019 Jul;36(8):828-834. doi: 10.1055/s-0038-1675329. Epub 2018 Nov 2.


Background: Epidural analgesia is associated with a fourfold increased rate of intrapartum fever. The likely pathophysiology is a noninfectious maternal inflammatory activation. Safe interventions to reduce maternal and neonatal exposures to intrapartum fever and inflammation are needed.

Objective: The purpose of this study was to determine if prophylactic epidural steroids decrease fetal exposure to hyperthermia and inflammatory cytokines following epidural analgesia.

Study design: This is a randomized, double-blinded, placebo controlled trial. Term nulliparous women requesting epidural analgesia received 80 mg methylprednisolone or preservative-free normal saline via the epidural catheter at placement. The primary outcome was maternal temperature >100.4°F. Secondary outcomes included fetal exposure to inflammation as assessed by cord blood interleukin-6 (IL-6) levels and rates of funisitis. Power analysis estimated a sample size requirement of 276, but new Food and Drug Administration (FDA) recommendations advising a black box warning on epidural steroids resulted in early study termination.

Results: A total of 116 subjects were enrolled: 58 treatments and 58 placebos. There was no difference in the rate of maternal intrapartum fever or cord blood IL-6 levels between treatment arms. No complications listed in the FDA warning occurred.

Conclusion: Prophylactic epidural methylprednisolone was not effective in reducing intrapartum fever or neonatal inflammation following epidural analgesia. Alternate mechanisms and preventative strategies should be considered.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesia, Epidural / adverse effects*
  • Analgesia, Obstetrical / adverse effects*
  • Double-Blind Method
  • Female
  • Fetal Blood / immunology
  • Fever / etiology
  • Fever / prevention & control*
  • Glucocorticoids / therapeutic use*
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / etiology
  • Infant, Newborn, Diseases / prevention & control*
  • Inflammation / etiology
  • Inflammation / prevention & control*
  • Interleukin-6 / blood*
  • Male
  • Methylprednisolone / therapeutic use*
  • Pregnancy
  • Risk Factors


  • Glucocorticoids
  • Interleukin-6
  • Methylprednisolone