Less May Be More, When It Comes to Steroids for Preterm Labor
Feb. 4, 2000 (Miami) -- Women at risk of delivering a premature baby are often given multiple doses of steroids to hasten fetal lung development and to ward off respiratory distress in the newborn. However, one dose may offer the same benefit and multiple doses could cause infection and death. That's according to preliminary research here at a meeting of maternal-fetal medicine.
Research shows possible links between repeat dosing and certain complications. In one study, M. Sean Esplin, MD, and colleagues found that children who were treated before birth with repeat doses of steroids were more likely at 9 and 18 months old to have certain developmental delays than those who received one dose and those who had not received steroids at all. Esplin is a fellow in maternal-fetal medicine at the University of Utah in Salt Lake City.
Repeat dosing may also increase the risk of infection and death, says Stephen T. Vermillion, MD. In his study of 453 infants, the mothers who received multiple doses were more likely to have infections in the uterus than were those who had received single doses. The multiple-dose infants were more likely to have infections and were more likely to die in the newborn period than were single-dose infants. Vermillion, a maternal-fetal medicine fellow, is associated with the Medical University of South Carolina in Charleston.
"[W]e have seen no benefit to repetitive doses," Debra Guinn, MD, tells WebMD. "[Steroids] shouldn't be used [prenatally] on a weekly basis."
In a study Guinn conducted at several centers, women received either a single dose or weekly doses of betamethasone, a common steroid used to prevent complications from preterm labor. In addition to showing no improvement in lung function of the newborn, the group that received the weekly dose of steroids had no improvement in terms of several other problems associated with prematurity: severe infection, a complication of the lower digestive tract often seen in premature newborns known as necrotizing enterocolitis, or death in the first month of life. Guinn is an assistant professor of maternal-fetal medicine at the University of Colorado at Denver.
Repeat steroid doses offer no benefit in terms of the newborn's outcome, Charles J. Lockwood, MD, tells WebMD. "If a woman has preterm labor symptoms, she should ask her doctor about steroids, but a [repeat] dose is usually not given unless birth is imminent." He is the director of the study presented by Guinn and the chair of obstetrics and gynecology at New York University Medical Center.
The investigators' findings, and the opinions they have formed, were echoed in an editorial published in the most recent issue of the British Medical Journal. Authors Chris Spencer, MD, and Kate Neales, MD, "suggest that only a single course ... should be given," until confirming data surface from a multicenter, randomized trial.
A wait-and-see approach will be helpful in the meantime, say Ronald S. Gibbs, MD, and Valerie M. Parisi, MD, MPH, who moderated the panel. "Data presented here are highly preliminary and will be scrutinized prior to publication [in a scientific journal]," Parisi tells WebMD. She is the chairwoman of obstetrics and gynecology at the University of North Carolina at Chapel Hill. "Similarly, these investigators' findings will have to be confirmed in larger studies."
A woman at risk of preterm birth should discuss treatment plans with her physician, says Gibbs, chairman of obstetrics and gynecology at the University of Colorado in Denver. He and Parisi suggest that such patients ask their physicians about the risks and benefits of any treatment, including prenatal steroids, so that they feel comfortable with their physicians' care decisions.