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
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.
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Joint Accreditation Statement
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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
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
Neonatal composite of treatment in the first 72 hours or stillbirth or neonatal death within 72 hours after delivery
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)
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
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
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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