Antenatal corticosteroids: FIGO states they should not be given “just in case”

Lung maturation is a crucial process in fetal development, as the lungs are the organs that allow breathing and the exchange of oxygen and carbon dioxide in the body. In premature babies, the lungs are often immature, which can lead to serious respiratory complications and even death.

Antenatal corticosteroids are a commonly used treatment with the aim of promoting lung maturation of the fetus and reducing the risk of respiratory distress syndrome and other complications.

Clinical studies have shown that intramuscular administration of antenatal corticosteroids significantly reduces the risk of respiratory distress syndrome in premature neonates, a serious complication that affects the ability of the lungs to expand and contract appropriately.

In addition to promoting lung maturity, antenatal corticosteroids also have other benefits for premature babies. For example, these drugs have been found to reduce the risk of intraventricular hemorrhage, a common complication in premature neonates that can lead to long-term neurological disabilities. Additionally, they have been shown to decrease the need for respiratory support and the length of stay in the neonatal intensive care unit, which in turn reduces the costs associated with the medical care of premature babies.

According to the American College of Obstetricians and Gynecologists (ACOG) and the International Federation of Gynecology and Obstetrics (FIGO), the administration of antenatal corticosteroids is recommended in women with a pregnancy between 24 and 34 weeks who are at risk of preterm birth within the next seven days.

Given the demonstrated benefits, it could be inferred that its routine administration would also benefit fetuses without immediate risk of premature birth, which could induce some physicians to consider its use beyond 34 weeks. However, FIGO has issued a special statement against this practice of administering them “just in case.” In fact, studies have revealed that such an approach may be associated with an increased risk of long-term complications, including neurocognitive disorders during childhood.

It is imperative to emphasize that the administration of antenatal corticosteroids must be carried out under strict specialized medical supervision and in accordance with specific guidelines regarding dosage and duration of treatment. Furthermore, it is essential to adequately inform mothers about the possible benefits and risks associated with the use of antenatal corticosteroids and to actively involve them in the decision-making process.

Blog by Dr. Nestor Ferrer, OB/GYN

1. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006;(3):CD004454. Published 2006 Jul 19. doi:10.1002/14651858.CD004454.pub2
2. Norman J, Shennan A, Jacobsson B, Stock SJ; FIGO Working Group for Preterm Birth. FIGO good practice recommendations on the use of prenatal corticosteroids to improve outcomes and minimize harm in babies born preterm [published correction appears in Int J Gynaecol Obstet. 2022 May;157(2):486]. Int J Gynaecol Obstet. 2021;155(1):26-30. doi:10.1002/ijgo.13836
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4. Committee on Obstetric Practice. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol. 2017;130(2):e102-e109. doi:10.1097/AOG.0000000000002237