Antenatal corticosteroids for low and middle income countries

Alan H Jobe; Matthew W Kemp; Beena Kamath-Rayne; Augusto F Schmidt

doi:10.1053/j.semperi.2019.03.012

Antenatal corticosteroids for low and middle income countries

Semin Perinatol. 2019 Aug;43(5):241-246. doi: 10.1053/j.semperi.2019.03.012. Epub 2019 Mar 18.

Authors

Alan H Jobe¹, Matthew W Kemp², Beena Kamath-Rayne³, Augusto F Schmidt⁴

Affiliations

¹ Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7029, Cincinnati, OH 45248, USA; University of Western Australia, Perth, Australia. Electronic address: Alan.jobe@cchmc.org.
² University of Western Australia, Perth, Australia; Tohoku University Hospital, Sendai, Japan; Murdock University, Perth, Australia.
³ Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7029, Cincinnati, OH 45248, USA.
⁴ University of Miami, Coral Gables, FL, USA.

PMID: 30979597
DOI: 10.1053/j.semperi.2019.03.012

Abstract

Antenatal corticosteroids (ACS) are sporadically used in low and middle income countries (LMIC), although their use is considered by the World Health Organization (WHO) as essential for decreasing infant mortality. Presently the WHO recommends the use of ACS only when gestational age is known, delivery is imminent, and the delivery will be in a facility that can provide care for the mother and the infant. We review uncertainties about ACS in high income countries that are underappreciated for anticipating their effectiveness in LMIC. We discuss the implications of a large RCT that evaluated the use of ACS in LMIC and found no benefit for presumed preterm infants and increased mortality in larger infants. The treatment schedules for ACS have not been optimized and more is now known about how to improve treatment strategies to hopefully decrease risks such as neonatal hypoglycemia in LMIC. The benefits from ACS may depend on the patient populations and health care environment in which the therapy is used. Further trials are needed to evaluate the safety and efficacy of ACS in LMIC.

Keywords: Betamethasone; Dexamethasone; Infant mortality; Low and middle income countries; Prematurity.

Publication types

Review

MeSH terms

Adrenal Cortex Hormones / administration & dosage*
Adult
Developing Countries / statistics & numerical data*
Drug Administration Schedule
Female
Gestational Age
Guidelines as Topic
Humans
Infant
Infant Mortality
Infant, Premature
Infant, Premature, Diseases / mortality
Infant, Premature, Diseases / prevention & control*
Obstetric Labor, Premature / drug therapy*
Obstetric Labor, Premature / mortality
Pregnancy
Prenatal Care* / statistics & numerical data
Randomized Controlled Trials as Topic
World Health Organization

Substances

Adrenal Cortex Hormones