Multiple Courses of Prenatal Steroids Should Be Avoided.

Higher rates of chorioamnionitis, infant sepsis seen among women with PROM.

RENO, NEV. -- Evidence continues to mount that multiple courses of prenatal steroids should not be routinely used in women at risk for preterm de livery.

In one multicenter, double-blind, placebo-controlled trial presented at the annual meeting of the Society for Maternal-Fetal Medicine, there was no difference in composite neonatal morbidity between babies born to women who had received single vs. multiple courses of steroids. But among women with premature rupture of membranes (PROM), there were higher rates of chorioamnionitis and neonatal sepsis in those who had received multiple courses, said Dr. Debra Guinn of the Denver Health Medical Center.

These findings lend further support to a recommendation made last year by a National Institutes of Health consensus panel that women at risk for preterm delivery should not routinely receive repeated courses of prenatal corticosteroids to hasten fetal pulmonary development.

Available data do not prove that multiple courses either benefit or harm the mother and fetus, the panel said. Some data have linked multiple steroid doses to adverse outcomes in the fetus and neonate, including death, growth restriction, and impaired brain development. Other studies, however, have shown that multiple courses may reduce the incidence of respiratory distress syndrome (RDS) and patent ductus arteriosus.

In the current study, which included 502 women at risk of preterm delivery, there was a statistically significant reduction in cases of severe RDS when multiple courses were given, compared with single courses. "But while reduction in severe RDS is a laudable goal, it did not translate into improved survival, decreased rates of bronchopulmonary dysplasia, or shorter hospital stays," Dr. Guinn said.

All patients in the study received a complete course of intramuscular beclomethasone--12 mg every 24 hours for a total of two doses. A total of 250 women then were randomized to receive repeated weekly courses until they were delivered or reached 34 weeks' gestation, while 236 women received placebo injections.