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Antenatal glucocorticoids: where are we after forty years?

Published online by Cambridge University Press:  03 December 2014

C. J. D. McKinlay ,
S. R. Dalziel  and
J. E. Harding
C. J. D. McKinlay
Affiliation:
Liggins Institute, The University of Auckland, Auckland, New Zealand
S. R. Dalziel
Affiliation:
Children’s Emergency Department, Starship Children’s Health, Auckland, New Zealand
J. E. Harding*
Affiliation:
Liggins Institute, The University of Auckland, Auckland, New Zealand
*
*Address for correspondence: Professor J. E. Harding, Liggins Institute, The University of Auckland, Private Bag 92019, Victoria St West, Auckland 1142, New Zealand. (Email [email protected])
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Abstract

Since their introduction more than forty years ago, antenatal glucocorticoids have become a cornerstone in the management of preterm birth and have been responsible for substantial reductions in neonatal mortality and morbidity. Clinical trials conducted over the past decade have shown that these benefits may be increased further through administration of repeat doses of antenatal glucocorticoids in women at ongoing risk of preterm and in those undergoing elective cesarean at term. At the same time, a growing body of experimental animal evidence and observational data in humans has linked fetal overexposure to maternal glucocorticoids with increased risk of cardiovascular, metabolic and other disorders in later life. Despite these concerns, and somewhat surprisingly, there has been little evidence to date from randomized trials of longer-term harm from clinical doses of synthetic glucocorticoids. However, with wider clinical application of antenatal glucocorticoid therapy there has been greater need to consider the potential for later adverse effects. This paper reviews current evidence for the short- and long-term health effects of antenatal glucocorticoids and discusses the apparent discrepancy between data from randomized clinical trials and other studies.

Keywords

antenatal glucocorticoidspreterm birthcardiovascular risk factorsdevelopmental origins of health and disease
Type
Review
Information
Journal of Developmental Origins of Health and Disease , Volume 6 , Issue 2 , April 2015 , pp. 127 - 142
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Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2014 

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