SMFM Statement: Implementation of the Use of Antenatal Corticosteroids in the Late Preterm Birth Period in Women at Risk for Preterm Delivery Tags: corticosteriod , late preterm Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trialThe feasibility and impact of implementing NICE guidance on diabetes control during deliveryClinical outcomes of pregnancy in women with type 1 diabetesInfluence of the maternal plasma glucose concentration at delivery on the risk of hypoglycaemia in infants of insulin‐dependent diabetic mothersManagement of the insulin‐dependent diabetic during labor and delivery. However, there are concerns regarding the cognitive functioning of children exposed to antenatal corticosteroid therapy prior to elective Caesarean section at term gestation (Low).Betamethasone has been more commonly used in studies evaluating the effect of antenatal corticosteroid therapy.
Antenatal corticosteroid therapy may be considered if early intensive care is requested and planned (Conditional, Low).The balance of risks and benefits does not support routine administration of antenatal corticosteroid therapy for women at 35 + 0 to 35 + 6 weeks gestation who are at high risk for preterm birth in the next 7 days (Conditional, Moderate).Antenatal corticosteroid therapy should not be routinely administered to women at 36 + 0 to 36 + 6 weeks gestation who are at risk for preterm delivery (Conditional, Moderate).Antenatal corticosteroid therapy may be administered between 35 + 0 and 36 + 6 weeks gestation in select clinical situations after risks and benefits are discussed with the woman and the pediatric care provider(s) (Conditional, Moderate).Elective pre-labour Caesarean section should be performed at or after 39 + 0 weeks gestation to minimize respiratory morbidity (Strong, Low).Antenatal corticosteroid therapy should not be routinely administered to women undergoing pre-labour Caesarean section at term gestation (including at 37 and 38 weeks gestation) (Strong, Low).When antenatal corticosteroid therapy is indicated, women should receive a course of antenatal corticosteroid therapy (i.e., either 2 doses of betamethasone 12 mg given by intramuscular injection 24 hours apart or 4 doses of dexamethasone 6 mg given by intramuscular injection 12 hours apart) (Strong, Moderate).Antenatal corticosteroid therapy should be administered to women requiring medically indicated delivery only when the plan to proceed with delivery within 7 days has been finalized and gestational age criteria for antenatal corticosteroid therapy are met (Strong, Low).Antenatal corticosteroid therapy should be routinely administered to women in spontaneous preterm labour characterized by Regular contractions in the absence of cervical dilation/change, or a short cervical length in the absence of regular contractions, are not indications for antenatal corticosteroid therapy (Strong, Low).Antenatal corticosteroid therapy should be routinely administered at the time of diagnosis to women with preterm premature rupture of membranes, when gestational age criteria are met (Strong, Low).Antenatal corticosteroid therapy should be administered to women with significant antepartum hemorrhage when the risk of delivery within 7 days is high and the gestational age criteria for such therapy are met (Strong, Low).Antenatal corticosteroid therapy should be administered to asymptomatic patients with vasa previa or placenta previa when the risk of delivery within 7 days is high and the gestational age criteria are met (Strong, Low).In cases where the diagnosis of preterm labour has not been firmly established (i.e., no documented cervical change and dilatation <3 cm), and the woman is being transferred to a higher level of care for further assessment, antenatal corticosteroid therapy should not be administered prior to transfer (Strong, Low).If the risk of preterm delivery decreases significantly following administration of the first dose of antenatal corticosteroid therapy, cancellation of the second dose of corticosteroids should be considered.
Local institutions can dictate amendments to these opinions.