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Antenatal steroids may be safe in preterm labor with chorioamnionitis

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Results of a meta-analysis indicate that antenatal steroids seem safe and reduce adverse outcomes in preterm infants when the pregnancy is complicated by chorioamnionitis, a Dutch team reports.

Giving mothers corticosteroids has become standard when preterm delivery is expected, note Dr. Jasper V. Been and colleagues at Maastricht University Medical Centre, in their report in the November 4 online issue of the BJOG. “However, general concern exists regarding the administration of antenatal steroids in cases of suspected intrauterine infection.”

To assess the available evidence on the issue, the researchers analyzed data from seven relevant observational studies. They report results separately for a histologic diagnosis of chorioamnionitis (i.e., confirmed after birth) and clinical diagnosis before birth “because of important diagnostic differences between the two.”

In histological chorioamnionitis, administration of antenatal steroids was associated with significant reductions in neonatal mortality (OR, 0.45), RDS (OR, 0.53), patent ductus arteriosus (OR, 0.56), intraventricular hemorrhage (OR, 0.35) and severe IVH (OR, 0.39). “No significantly increased risk for any adverse outcome was detected after antenatal steroids,” the researchers report.

In cases of clinical chorioamnionitis, antenatal steroids were associated with significant reductions in severe neonatal IVH (OR, 0.29) and periventricular leukomalacia (OR, 0.35). Antenatal steroid were not associated with any adverse outcomes in this setting either.

Dr. Been and colleagues conclude, “Antenatal steroids may be safe and reduce adverse neonatal outcome after preterm birth associated with chorioamnionitis.”

Nonetheless, they are cautious about making any clinical recommendations. As they point out, “Additional research is needed to evaluate the maternal and long-term offspring effects of antenatal steroids in chorioamnionitis.”

BJOG 2010;