Question 53

Between 35+0 and 36+6 weeks, antenatal corticosteroids are not recommended as an automatic intervention for every woman at risk of birth. Instead, the potential benefits and harms should be considered and discussed. Evidence in the late-preterm period suggests a reduction in the need for neonatal respiratory support, but this is accompanied by an increased risk of neonatal hypoglycaemia. In the major late-preterm trial, respiratory support occurred in 11.6% of corticosteroid-exposed infants compared with 14.4% after placebo, whereas neonatal hypoglycaemia occurred in 24.0% compared with 15.0%. The approximate number needed to treat was 35 and the number needed to harm was 11. Therefore, at 35+5 weeks the appropriate approach is individualised counselling rather than routine administration or automatic withholding. The likelihood of birth, neonatal respiratory benefit, hypoglycaemia risk and the woman’s preferences should all inform the decision.

B) Routine treatment of every woman before 37 weeks is not recommended in the late-preterm period.

C) Corticosteroids may still provide respiratory benefit after 34+6 weeks, although the balance of benefit and harm changes.

D) Delivery should not routinely be delayed solely to create a 48-hour corticosteroid interval.

E) Fetal lung maturity testing is not required before deciding about corticosteroids.

F) Routine repeated courses until birth are not recommended.

G) Consideration of corticosteroids at 35+5 weeks is not restricted to planned caesarean birth.

H) Potential benefit may occur even when birth follows treatment within 24 hours.

Stock SJ, Thomson AJ, Papworth S, on behalf of the Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG. 2022;129:e35–e60. RCOG Green-top Guideline No. 74. doi:10.1111/1471-0528.17027.