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Warning on steroid use for prematurity
Title: The effects of repeat doses of antenatal corticosteroids on maternal adrenal function
Author: D. McKena, et al.
Address: Columbus, Ohio
Source: American Journal of Obstetrics and Gynecology 183:669-673 (September) 2000
Summary: Researchers conducted this study to learn if repeated doses of maternal corticosteroids suppress the maternal hypothalamic-pituitary-adrenal axis. Subjects were 18 pregnanct women who had received at least 2 weekly courses of antenatal bethamethasone and 6 control subjects matched for gestational age who had not received antenatal corticosteroids. All subjects were given the low-dose corticotropin stimulation test an average of 3 days after the last bethamethasone dose. When compared to the control subjects, the average basal cortisol level was significantly depressed in women who had been given bethamethasone. The maternal cortisol level after corticotropin stimulation was significantly longer among those who had received betamethasone than among the controls. Researchers concluded that repeated courses of betamethasone lead to barely detectable maternal basal cortisol levels and secondary adrenal insufficiency. They advise that the benefits and risks must be carefully weighed before repeated dosing with antenatal corticosteroids.
Comment: It is now recommended and standard practice to administer a single dose of steroids to those at high risk for preterm delivery. There may be considerable difference between the benefit of one and multiple doses. A major question remains about the effect corticosteroids have on the fetal adrenal axis. could they cause an early activation?