In this episode Dr. Øystein Bergøy discusses the evidence behind the risks of antenatal corticosteroids for women at risk for preterm delivery. 

 

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• ACOG guidelines on fetal maturation 
• NICE guidelines on risk of premature labour 
• Norwegian guidelines on risk of premature labour 
• 2015 cochrane analysis of repeat steroids 
• Study were microsimulation was used to make a ratio of benefits vs harms of repeat steroids according to gestational age at birth 
• Uptodate.com article on antenatal steroids 
• study showing increased rds 1 to 24 hrs after booster dose
• Review from Nature in 2001 mentioning several animall studies that show negative effects of excess corticosteroids in utero
• Animal study from Kidney Int from 2000 showing increased risk of glucose intolerance with exogenous corticosteroid exposure in utero 
• Study in baboons from Nature in 2012 showing impaired myelination after exposure to repeat antenatal steroids 
• 3 studies that have shown impaired stress response inneonates exposed to antenatal steroids
• • https://www.ncbi.nlm.nih.gov/pubmed/?term=Antenatal+betamethasone+administration+alters+stress+physiology+in+healthy+neonates
  • https://www.ncbi.nlm.nih.gov/pubmed/?term=Effects+of+prenatal+betamethasone+exposure+on+regulation+of+stress+physiology+in+healthy+premature+infants
  • https://www.ncbi.nlm.nih.gov/pubmed/?term=Neonatal+adrenal+function+after+repeat+dose+prenatal+corticosteroids%3A+a+randomized+controlled+trial
  • https://www.ncbi.nlm.nih.gov/pubmed/?term=Multiple+courses+of+antenatal+corticosteroids+and+outcome+of+premature+neonates.+North+American+Thyrotropin-Releasing+Hormone+Study+Group
• Study showing impaired HPA function in children 6-11 years of age exposed to antenatal steroids 
• Study showing signs of glucose intolerance in participant who received antenatal steroids compared to placebo
• Study showing increased aortic stiffness in those exposed to antenatal steroids
• crowther et al mid childhood neurocgognitive development 
• meta analysis from 2016 in BMJ examining benefits and harms of antenatal steroids between 34 and 36 weeks gestation