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

Related ObG Topics:

Prediction and Prevention of Preterm Birth

Antenatal Corticosteroids – When to Administer?

Cochrane Update: Antenatal Corticosteroids and Impact on Respiratory Morbidity or Death in Preterm Births

In Women at Risk of Late Preterm Delivery, is Corticosteroid Therapy Still Cost-Effective?