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SMFM Issues Guidance on Antenatal Corticosteroid Use and Late Preterm Delivery

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Discuss the findings in the Antenatal Late Preterm Steroids trial
2. Describe the key SMFM recommendations for the use of antenatal corticosteroids for individuals at risk for late preterm delivery

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 8/23/2021 through 12/15/2022, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours.

Read Disclaimer & Fine Print

SUMMARY:

SMFM, upon review of the latest clinical evidence, provides recommendations for the use of antenatal corticosteroids to individuals at risk for late preterm delivery. The primary goal of antenatal corticosteroid administration is to reduce neonatal morbidity. One of the key studies guiding these recommendations is the Antenatal Late Preterm Steroids (ALPS) trial, which was conducted under the auspices of the MFMU Network.

Summary of ALPS

Study design

RCT
Eligibility
- Nonanomalous singleton gestation
- High risk for preterm delivery (medically indicated or spontaneous) | Between 34w6d up to 36w6d
- Had not received prior antenatal glucocorticosteroids
- Individual were ineligible if diagnosed with pre-gestational diabetes, however pregnant patients with gestational diabetes were eligible for enrollment
Assigned to two injections 24 hours apart
- Betamethasone or
- Matching placebo
Primary outcome
- Neonatal composite of treatment in the first 72 hours or stillbirth or neonatal death within 72 hours after delivery

Results

Betamethasone use reduced adverse neonatal composite outcome when administered to individuals at risk for late preterm delivery
- Betamethasone group: 11.6%
- Placebo group: 14.4%
- Relative risk 0.80 (95% CI, 0.66 to 0.97; P=0.02)
Significant reductions in individual neonatal outcomes after Betamethasone were also seen, such as transient tachypnea of the newborn, surfactant use, and bronchopulmonary dysplasia
There were no significant differences in the incidence of chorioamnionitis or neonatal sepsis between betamethasone use and placebo
Neonatal hypoglycemia was more frequent in the cohort that received betamethasone compared to placebo (24.0% versus 15.0%) without differences in length of stay

SMFM Recommendations for Use of Late Preterm Betamethasone 2 Doses 12 mg IM 24 Hours Apart

Population included in ALPS: Recommended (1A Strong recommendation, high-quality evidence)
- Singleton
- Between 34w0d to 36w7d
- High risk of preterm birth within the next 7 days and prior to 37 weeks of gestation
Select populations not in the original ALPS trial: Suggest consideration for use in the following clinical scenarios (2C Weak recommendation, low quality evidence)
- Multiple gestations reduced to a singleton gestation ≥14w0d
- Fetal anomalies
- Expected to deliver in less than 12 hours
Low likelihood of delivery <37 weeks: Recommend against (1B Strong recommendation, moderate-quality evidence)
Pregestational diabetes: Recommend against due to risk for worsening neonatal hypoglycemia (1C Strong recommendation, low quality evidence)

Note: SMFM strongly recommends

…that patients at risk for late preterm delivery be thoroughly counseled regarding the potential risks and benefits of antenatal corticosteroid administration and be advised that the long-term risks remain uncertain

Learn More – Primary Sources:

Society for Maternal-Fetal Medicine (SMFM) Consult #58: Use of Antenatal Corticosteroids for Individuals at Risk for Late Preterm Delivery

Antenatal Betamethasone for Women at Risk for Late Preterm Delivery

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SMFM Issues Guidance on Antenatal Corticosteroid Use and Late Preterm Delivery