Antenatal Corticosteroids for Fetal Maturation: A Comprehensive Review of Major Guidelines.

IMPORTANCE

The administration of corticosteroids before anticipated preterm delivery represents a crucial antenatal intervention that enhances fetal lung maturity and reduces neonatal morbidity and mortality.

OBJECTIVE

This review aims to evaluate and compare the most recently published influential guidelines on the use of antenatal corticosteroids (ACS).

EVIDENCE ACQUISITION: A comparative review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the International Federation of Gynecology and Obstetrics (FIGO), the European Association of Perinatal Medicine (EAPM), the World Association of Perinatal Medicine (WAPM), the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) was carried out.

RESULTS

All the reviewed guidelines recommend the use of ACS between 24+0 and 33+6 weeks of gestation, when preterm delivery is anticipated and endorse the consideration of their use at the periviable period. In addition, there is an overall agreement regarding the recommended regimens and the use of ACS in case of pregnancies with existing comorbidities, such as preterm prelabor rupture of membranes, obesity, multiple pregnancy, fetal growth restriction, and diabetes. In contrast, the recommendations for the use of ACS in the late preterm period, in women with chorioamnionitis and in cases of recurrent or persistent threatened preterm delivery vary. Moreover, RCOG is the only medical society supporting that the administration of ACS in case of planned cesarean delivery should be considered up to 38+6 weeks of gestation.

CONCLUSIONS

The favorable role of corticosteroids in improving the outcomes of preterm neonates is clearly outlined. However, the explicit articulation of the potential benefits and harms stemming from their use at different stages of pregnancy and in different delivery contexts is yet to be elucidated. Thus, it seems of paramount importance to develop consistent recommendations for the use of this antenatal intervention to maximize its beneficial effects and eliminate the associated risks.