Antenatal Steroids: Supporting Healthy Outcomes for Preterm Infants

Introduction

Preterm birth, defined as the birth of a baby before 37 weeks of gestation, is a leading cause of neonatal morbidity and mortality worldwide. Preterm infants face significant health challenges due to their underdeveloped lungs and other vital organs. Antenatal steroids have emerged as a life-saving intervention to support the health and development of preterm infants, particularly by promoting lung maturity. This comprehensive guide explores antenatal steroids, their role in preterm birth management, and their benefits in improving neonatal outcomes.

This article also delves into the importance of antenatal care, the role of antenatal appointments, and how interventions such as antenatal yoga, antenatal massage, and other support measures are integrated into a holistic approach to pregnancy care.

What Are Antenatal Steroids?

Antenatal steroids are corticosteroid medications—betamethasone and dexamethasone—given to pregnant women at risk of preterm birth to accelerate the development of the fetus’s lungs and other organs. These steroids are administered through an injection, typically in two doses 24 hours apart. The primary goal of antenatal steroids is to stimulate the production of surfactant, a substance that helps keep the lungs inflated and allows for proper gas exchange.

Surfactant production is critical in the lungs’ ability to function properly, especially in preterm infants, whose lungs are often underdeveloped. By increasing the production of surfactant, antenatal steroids improve the ability of premature babies to breathe independently after birth, reducing the need for respiratory support and preventing complications such as respiratory distress syndrome (RDS).

The Benefits of Antenatal Steroids

1. Prevention of Respiratory Distress Syndrome (RDS)

Respiratory distress syndrome (RDS) is a common complication in preterm infants, resulting from insufficient surfactant production in the lungs. Antenatal steroids play a vital role in preventing RDS by stimulating the production of surfactant, significantly improving lung function and reducing the incidence of RDS in premature babies.

The benefits of antenatal steroids in reducing RDS are well-documented. Studies show that the administration of steroids decreases the need for mechanical ventilation in preterm infants and improves their ability to breathe on their own. In fact, antenatal steroids have been shown to reduce RDS by 50%, greatly improving the chances of survival for preterm infants. (World Health Organization, 2023)

2. Reducing Other Preterm Birth Complications

In addition to improving lung function, antenatal steroids are effective in reducing other common complications associated with preterm birth. These include:

Intraventricular haemorrhage (IVH): A condition where bleeding occurs in the brain of preterm infants, often leading to neurological damage.

Necrotising enterocolitis (NEC): A serious gastrointestinal disease affecting preterm babies.

Patent ductus arteriosus (PDA): A heart condition commonly seen in preterm infants.

By promoting the maturation of multiple fetal organs, antenatal steroids help prevent these complications, ultimately improving neonatal health outcomes and reducing the need for intensive care. (Royal College of Obstetricians and Gynaecologists, 2023)

3. Improving Long-Term Health Outcomes

The impact of antenatal steroids goes beyond the immediate neonatal period. Research has shown that babies who receive antenatal steroids have improved cognitive and motor development compared to those who do not. They are also less likely to experience behavioural problems later in life.

Studies indicate that infants who received antenatal steroids have a lower risk of developing conditions such as cerebral palsy, learning disabilities, and attention deficit disorders. These long-term benefits underscore the critical role of antenatal steroids in not just improving survival rates but also ensuring healthy development in preterm infants. (Mayo Clinic, 2023)

When Are Antenatal Steroids Recommended?

1. Indications for Antenatal Steroids

Antenatal steroids are recommended for pregnant women who are at risk of preterm birth. The following conditions often warrant the administration of antenatal steroids:

Threatened preterm labour: When labour begins before 34 weeks of gestation, especially when there is a high likelihood of preterm birth.

Multiple pregnancies: Pregnancies involving twins, triplets, or other multiples are at increased risk of preterm birth and may benefit from antenatal steroids.

Preterm premature rupture of membranes (PPROM): When the membranes rupture before 37 weeks of pregnancy, increasing the likelihood of preterm birth.

For optimal results, antenatal steroids should be administered between 24 and 34 weeks of gestation, as this is when the fetus’s lungs are most responsive to the steroids’ effects. The timing of antenatal steroid administration is crucial, and healthcare providers will consider each patient’s individual situation before administering the treatment. (National Institutes of Health, 2023)

2. Timing of Administration

Antenatal steroids are typically given when preterm birth is imminent and the pregnancy is between 24 and 34 weeks. The steroids are usually administered in two doses, 24 hours apart, and begin to take effect within 24 to 48 hours. It is essential that the timing of antenatal steroid administration is closely monitored to ensure maximum benefit to both mother and baby.

In cases where preterm labour occurs after 34 weeks, antenatal steroids may not be as beneficial, as the fetus’s lungs are often sufficiently developed by this point. However, they may still be recommended in certain situations, depending on the individual health risks involved. (American College of Obstetricians and Gynecologists, 2023)

Potential Risks and Side Effects of Antenatal Steroids

While antenatal steroids are generally safe, there are some potential risks and side effects that expectant mothers and healthcare providers should consider.

1. Potential Risks for the Mother

For the mother, the most common side effect of antenatal steroids is an increase in blood sugar levels, which can be particularly concerning for women with gestational diabetes or pre-existing diabetes. However, these effects are typically short-lived and resolve once the steroids are discontinued.

There is also a possibility of a slight increase in the risk of infections, as antenatal steroids can suppress the immune system. However, the risk is generally low, and healthcare providers closely monitor mothers receiving antenatal steroids to manage any complications. (American Pregnancy Association, 2023)

2. Potential Risks for the Baby

While antenatal steroids are crucial for improving outcomes in preterm infants, there are concerns about their potential long-term effects on the baby. Some studies have suggested that babies exposed to antenatal steroids may have a slightly increased risk of developing asthma or wheezing later in childhood. However, this risk is minimal compared to the benefits of antenatal steroids in preventing respiratory distress syndrome (RDS) and other life-threatening complications.

Additionally, there have been concerns about the possible behavioural effects of antenatal steroids, including an increased risk of hyperactivity. However, the research on these effects is inconclusive, and many studies have found no significant long-term impact. (Mayo Clinic, 2023)

The Importance of Antenatal Care in Preterm Birth Management

1. Comprehensive Antenatal Care

Antenatal steroids are an essential part of managing preterm birth, but they are just one component of a comprehensive antenatal care plan. Regular antenatal checkups, antenatal appointments, and antenatal scans are essential for monitoring the health of both the mother and baby during a high-risk pregnancy. These appointments allow healthcare providers to assess the risk of preterm birth, offer appropriate treatments like antenatal steroids, and provide necessary support to the mother.

In addition to medical interventions, antenatal care includes offering emotional and psychological support to the mother. Antenatal yoga, prenatal massage, and other relaxation techniques are often recommended to promote physical and mental well-being during pregnancy. (My Expert Midwife, 2023)

2. Antenatal Education and Support

Expectant parents also benefit from antenatal education, which provides vital information about childbirth, neonatal care, and managing the risks of preterm birth. By attending antenatal classes, parents can learn more about the role of antenatal steroids, prenatal care, and pregnancy yoga. These classes also offer an opportunity for parents to connect with others and receive much-needed emotional support during a stressful time. (NHS, 2023)

Conclusion

Antenatal steroids are a critical intervention in managing preterm birth, significantly improving neonatal health outcomes by promoting lung development and preventing complications like respiratory distress syndrome. While there are some risks associated with their use, the benefits far outweigh the potential downsides when the steroids are administered appropriately and under medical supervision.

Expectant mothers at risk of preterm birth should work closely with their healthcare providers to understand the role of antenatal steroids, as well as other aspects of antenatal care such as antenatal checkups, antenatal scans, and antenatal education. By staying informed and engaged in their pregnancy care, parents can ensure the best possible outcomes for their baby.