Auckland, New Zealand—Pregnant women at risk for very preterm birth often are given corticosteroids, sometimes repeatedly.

Previous research has indicated that even a single course of antenatal corticosteroid therapy administered to women at risk for preterm delivery reduced the incidence and severity of respiratory distress syndrome and mortality in offspring. Clinical trials also indicate that the therapy improves circulatory stability in preterm neonates, resulting in lower rates of intraventricular hemorrhage and necrotizing enterocolitis compared with unexposed preterm neonates.

The question, however, is how repeat doses of antenatal corticosteroids affect neurodevelopment and general health longer term, when the fetus reaches mid-childhood, 6 to 8 years of age. A study published recently in the journal Pediatrics sought to provide an answer.

For the study, University of Auckland Liggins Institute–led researchers randomized women at risk for very preterm birth, who had received a course of corticosteroids for 7 days or more days previously, to intramuscular betamethasone (11.4 mg Celestone Chronodose) or saline placebo, repeated weekly if risk of early delivery remained.

Assessed in mid-childhood were neurocognitive function, behavior, growth, lung function, blood pressure, health-related quality of life, and health service utilization. The primary outcome was survival free of neurosensory disability.

Results indicate that, of the 1,059 eligible long-term survivors, 963 (91%) were included in the primary outcome, 479 (91%) in the repeat corticosteroid group, and 484 (91%) in the placebo group.

The rate of survival free of neurosensory disability was similar in both groups, 78.3% repeat versus 77.3% placebo, for a risk ratio of 1.00.

Neurodevelopment, including cognitive function, and behavior, body size, blood pressure, spirometry, and health-related quality of life, were also similar in both groups, as was the use of health services, according to the report.

“Treatment with repeat dose(s) of antenatal corticosteroids was associated with neither benefit nor harm in mid-childhood,” study authors conclude. “Our finding of long-term safety supports the use of repeat dose(s) of antenatal corticosteroids, in view of the related neonatal benefits. For women at risk for preterm birth before 32 weeks’ gestation, ≥7 days after an initial course of antenatal corticosteroids, clinicians could consider using a single injection of betamethasone, repeated weekly if risk remains.”

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