Single versus weekly courses of antenatal corticosteroids: Evaluation of safety and efficacy

Ronald J. Wapner; Yoram Sorokin; Elizabeth A. Thom; Francee Johnson; Donald J. Dudley; Catherine Y. Spong; Alan M. Peaceman; Kenneth J. Leveno; Margaret Harper; Steve N. Caritis; Menachem Miodovnik; Brian Mercer; John M. Thorp; Atef Moawad; Mary Jo O'Sullivan; Susan Ramin; Marshall W. Carpenter; Dwight J. Rouse; Baha Sibai; Steven G. Gabbe

doi:10.1016/j.ajog.2006.03.087

Single versus weekly courses of antenatal corticosteroids: Evaluation of safety and efficacy

Ronald J. Wapner, Yoram Sorokin, Elizabeth A. Thom, Francee Johnson, Donald J. Dudley, Catherine Y. Spong, Alan M. Peaceman, Kenneth J. Leveno, Margaret Harper, Steve N. Caritis, Menachem Miodovnik, Brian Mercer, John M. Thorp, Atef Moawad, Mary Jo O'Sullivan, Susan Ramin, Marshall W. Carpenter, Dwight J. Rouse, Baha Sibai, Steven G. Gabbe

Research output: Contribution to journal › Article › peer-review

244 Scopus citations

Abstract

Objective: The purpose of this study was to determine if weekly corticosteroids improve neonatal outcome without undue harm. Study design: Women 23 to 32 weeks receiving 1 course of corticosteroids 7 to 10 days prior were randomized to weekly betamethasone or placebo. Results: The study was terminated by the independent data and safety monitoring committee with 495 of the anticipated 2400 patients enrolled. There was no significant reduction in the composite primary morbidity outcome (8.0% vs 9.1%, P = .67). Repeated courses significantly reduced neonatal surfactant administration (P = .02), mechanical ventilation (P = .004), CPAP (P = .05), pneumothoraces (P = .03). There was no significant difference in mean birth weight or head circumference. The repeat group had a reduction in multiples of the birth weight median by gestational age (0.88 vs 0.91) (P = .01) and more neonates weighing less than the 10th percentile (23.7 vs 15.3%, P = .02). Significant weight reductions occurred for the group receiving ≥4 courses. Conclusion: Repeat antenatal corticosteroids significantly reduce specific neonatal morbidities but do not improve composite neonatal outcome. This is accompanied by reduction in birth weight and increase in small for gestational age infants.

Original language	English (US)
Pages (from-to)	633-642
Number of pages	10
Journal	American journal of obstetrics and gynecology
Volume	195
Issue number	3
DOIs	https://doi.org/10.1016/j.ajog.2006.03.087
State	Published - Sep 2006

Keywords

Antenatal corticosteroids
Prematurity

ASJC Scopus subject areas

Obstetrics and Gynecology

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10.1016/j.ajog.2006.03.087

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Wapner, R. J., Sorokin, Y., Thom, E. A., Johnson, F., Dudley, D. J., Spong, C. Y., Peaceman, A. M., Leveno, K. J., Harper, M., Caritis, S. N., Miodovnik, M., Mercer, B., Thorp, J. M., Moawad, A., O'Sullivan, M. J., Ramin, S., Carpenter, M. W., Rouse, D. J., Sibai, B., & Gabbe, S. G. (2006). Single versus weekly courses of antenatal corticosteroids: Evaluation of safety and efficacy. American journal of obstetrics and gynecology, 195(3), 633-642. https://doi.org/10.1016/j.ajog.2006.03.087

Wapner, RJ, Sorokin, Y, Thom, EA, Johnson, F, Dudley, DJ, Spong, CY, Peaceman, AM, Leveno, KJ, Harper, M, Caritis, SN, Miodovnik, M, Mercer, B, Thorp, JM, Moawad, A, O'Sullivan, MJ, Ramin, S, Carpenter, MW, Rouse, DJ, Sibai, B & Gabbe, SG 2006, 'Single versus weekly courses of antenatal corticosteroids: Evaluation of safety and efficacy', American journal of obstetrics and gynecology, vol. 195, no. 3, pp. 633-642. https://doi.org/10.1016/j.ajog.2006.03.087

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abstract = "Objective: The purpose of this study was to determine if weekly corticosteroids improve neonatal outcome without undue harm. Study design: Women 23 to 32 weeks receiving 1 course of corticosteroids 7 to 10 days prior were randomized to weekly betamethasone or placebo. Results: The study was terminated by the independent data and safety monitoring committee with 495 of the anticipated 2400 patients enrolled. There was no significant reduction in the composite primary morbidity outcome (8.0% vs 9.1%, P = .67). Repeated courses significantly reduced neonatal surfactant administration (P = .02), mechanical ventilation (P = .004), CPAP (P = .05), pneumothoraces (P = .03). There was no significant difference in mean birth weight or head circumference. The repeat group had a reduction in multiples of the birth weight median by gestational age (0.88 vs 0.91) (P = .01) and more neonates weighing less than the 10th percentile (23.7 vs 15.3%, P = .02). Significant weight reductions occurred for the group receiving ≥4 courses. Conclusion: Repeat antenatal corticosteroids significantly reduce specific neonatal morbidities but do not improve composite neonatal outcome. This is accompanied by reduction in birth weight and increase in small for gestational age infants.",

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doi = "10.1016/j.ajog.2006.03.087",

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T2 - Evaluation of safety and efficacy

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Thom, Elizabeth A.

AU - Johnson, Francee

AU - Dudley, Donald J.

AU - Spong, Catherine Y.

AU - Peaceman, Alan M.

AU - Leveno, Kenneth J.

AU - Harper, Margaret

AU - Caritis, Steve N.

AU - Miodovnik, Menachem

AU - Mercer, Brian

AU - Thorp, John M.

AU - Moawad, Atef

AU - O'Sullivan, Mary Jo

AU - Ramin, Susan

AU - Carpenter, Marshall W.

AU - Rouse, Dwight J.

AU - Sibai, Baha

AU - Gabbe, Steven G.

PY - 2006/9

Y1 - 2006/9

N2 - Objective: The purpose of this study was to determine if weekly corticosteroids improve neonatal outcome without undue harm. Study design: Women 23 to 32 weeks receiving 1 course of corticosteroids 7 to 10 days prior were randomized to weekly betamethasone or placebo. Results: The study was terminated by the independent data and safety monitoring committee with 495 of the anticipated 2400 patients enrolled. There was no significant reduction in the composite primary morbidity outcome (8.0% vs 9.1%, P = .67). Repeated courses significantly reduced neonatal surfactant administration (P = .02), mechanical ventilation (P = .004), CPAP (P = .05), pneumothoraces (P = .03). There was no significant difference in mean birth weight or head circumference. The repeat group had a reduction in multiples of the birth weight median by gestational age (0.88 vs 0.91) (P = .01) and more neonates weighing less than the 10th percentile (23.7 vs 15.3%, P = .02). Significant weight reductions occurred for the group receiving ≥4 courses. Conclusion: Repeat antenatal corticosteroids significantly reduce specific neonatal morbidities but do not improve composite neonatal outcome. This is accompanied by reduction in birth weight and increase in small for gestational age infants.

AB - Objective: The purpose of this study was to determine if weekly corticosteroids improve neonatal outcome without undue harm. Study design: Women 23 to 32 weeks receiving 1 course of corticosteroids 7 to 10 days prior were randomized to weekly betamethasone or placebo. Results: The study was terminated by the independent data and safety monitoring committee with 495 of the anticipated 2400 patients enrolled. There was no significant reduction in the composite primary morbidity outcome (8.0% vs 9.1%, P = .67). Repeated courses significantly reduced neonatal surfactant administration (P = .02), mechanical ventilation (P = .004), CPAP (P = .05), pneumothoraces (P = .03). There was no significant difference in mean birth weight or head circumference. The repeat group had a reduction in multiples of the birth weight median by gestational age (0.88 vs 0.91) (P = .01) and more neonates weighing less than the 10th percentile (23.7 vs 15.3%, P = .02). Significant weight reductions occurred for the group receiving ≥4 courses. Conclusion: Repeat antenatal corticosteroids significantly reduce specific neonatal morbidities but do not improve composite neonatal outcome. This is accompanied by reduction in birth weight and increase in small for gestational age infants.

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KW - Prematurity

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Single versus weekly courses of antenatal corticosteroids: Evaluation of safety and efficacy

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