Antenatal steroids are given to pregnant women at risk of preterm delivery to accelerate fetal lung maturation, reduce neonatal complications, and improve survival.
Key Roles of Antenatal Steroids
- Fetal lung maturation: Stimulates surfactant production, reducing risk of respiratory distress syndrome (RDS).
- Reduction in neonatal mortality: Decreases risk of death in preterm infants.
- Prevention of complications: Lowers incidence of intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and systemic infections.
- Neurodevelopmental benefit: Associated with improved long-term neurological outcomes.
- Benefit across gestational ages: Most effective between 24–34 weeks, but can be considered as early as 23 weeks and up to 36+6 weeks in selected cases.
Clinical Indications
- Threatened preterm labor (before 34 weeks).
- Preterm premature rupture of membranes (PPROM).
- Elective early delivery for maternal/fetal indications (e.g., severe preeclampsia, IUGR).
- Multiple gestations at risk of early birth.
Regimens
- Betamethasone: 12 mg IM every 24 hours × 2 doses.
- Dexamethasone: 6 mg IM every 12 hours × 4 doses.
- Both are equally effective; choice depends on availability and local guidelines.
Repeat Courses
- Single repeat course may be considered if risk of preterm birth persists after 14 days from initial course (<34 weeks).
- Rescue course can be given as early as 7 days after prior dose if clinically indicated.
Limitations & Considerations
- Not recommended routinely after 37 weeks.
- Caution in maternal infection (may mask signs).
- Long-term safety: Generally safe, but ongoing surveillance of neurodevelopmental outcomes is advised.