Antenatal Steroids: What Expectant Parents Need to Know

Introduction

Pregnancy brings many challenges, and one of the most significant is the risk of preterm birth. Preterm infants face numerous health risks, including respiratory distress syndrome (RDS), which can lead to serious complications if not properly managed. One critical intervention for women at risk of preterm labour is the administration of antenatal steroids. These steroids have proven to be a life-saving treatment, improving neonatal health outcomes and reducing the risks associated with premature birth.

For expectant parents, it is essential to understand how antenatal steroids work, the benefits they provide, and the potential risks involved. In this article, we will explore antenatal steroids in detail, explaining their role in pregnancy, how they are used, and what expectant parents need to know about them.

What Are Antenatal Steroids?

Antenatal steroids are corticosteroid medications, most commonly betamethasone or dexamethasone, that are administered to pregnant women who are at risk of delivering prematurely. These steroids work by accelerating the development of fetal organs, particularly the lungs, which are often underdeveloped in preterm infants.

The administration of antenatal steroids typically involves two injections given 24 hours apart, which cross the placenta and stimulate the baby’s organs to mature. This helps the baby’s lungs produce surfactant, a substance that allows the lungs to inflate properly after birth. Antenatal steroids are typically administered between 24 and 34 weeks of gestation, as this is the most effective period for promoting lung development in preterm babies.

Why Are Antenatal Steroids Important for Preterm Birth?

1. Preventing Respiratory Distress Syndrome (RDS)

The primary reason antenatal steroids are administered is to prevent respiratory distress syndrome (RDS) in preterm infants. RDS is a condition caused by insufficient surfactant in the lungs, leading to breathing difficulties. Premature infants, particularly those born before 28 weeks of gestation, often lack enough surfactant to keep their lungs properly inflated.

By promoting the production of surfactant, antenatal steroids significantly reduce the risk of RDS, enabling preterm babies to breathe more easily and decreasing their need for mechanical ventilation. The use of antenatal steroids has been shown to decrease the incidence of RDS by up to 50%, greatly improving survival rates for preterm infants. (World Health Organization, 2023)

2. Reducing Other Preterm Birth Complications

In addition to preventing RDS, antenatal steroids reduce the risk of several other complications associated with preterm birth, including:

Intraventricular haemorrhage (IVH): Bleeding in the brain, often seen in infants born prematurely.

Necrotising enterocolitis (NEC): A serious intestinal condition that affects preterm infants.

Patent ductus arteriosus (PDA): An abnormal heart condition that can occur in premature infants.

By enhancing the development of the brain, intestines, and other organs, antenatal steroids help reduce the severity of these conditions, leading to improved neonatal health outcomes. Babies who receive antenatal steroids experience fewer complications and better long-term health prospects. (Royal College of Obstetricians and Gynaecologists, 2023)

3. Improving Long-Term Development

Research has shown that the benefits of antenatal steroids extend beyond the neonatal period. Babies who receive antenatal steroids have improved cognitive, motor, and behavioural development. Long-term studies suggest that infants who were exposed to antenatal steroids are less likely to experience developmental delays, learning difficulties, or other health problems associated with prematurity.

This long-term benefit is crucial, as antenatal steroids do not only support the immediate health of the baby but also contribute to better outcomes as the child grows. (National Institutes of Health, 2023)

Risks and Side Effects of Antenatal Steroids

1. Potential Risks for the Mother

While antenatal steroids are generally considered safe, there are some risks to the mother. The most common side effect is an increase in blood sugar levels, particularly for women with gestational diabetes. Elevated blood sugar levels can complicate pregnancy care, but these effects are usually short-lived and reversible once the medication is stopped.

In some cases, antenatal steroids can also suppress the immune system, increasing the risk of infections. However, these risks are generally minor and are outweighed by the benefits for the baby, especially when steroids are administered under medical supervision. (American Pregnancy Association, 2023)

2. Potential Risks for the Baby

Some research suggests that babies exposed to antenatal steroids may face a slightly increased risk of developing asthma or wheezing later in childhood. However, this risk is generally low, and the benefits of antenatal steroids in improving neonatal survival and reducing complications far outweigh this concern.

There is also some evidence to suggest that antenatal steroids may have behavioural effects on children, such as hyperactivity or learning difficulties, but these findings are inconsistent and the effects tend to be mild. The vast majority of studies show that the benefits of antenatal steroids significantly outweigh these minor risks. (Mayo Clinic, 2023)

When Are Antenatal Steroids Administered?

1. Indications for Antenatal Steroids

Antenatal steroids are typically recommended when a woman is at risk of delivering prematurely. The most common indications for the administration of antenatal steroids include:

Threatened preterm labour: When labour begins before 34 weeks and there is a high likelihood of premature delivery.

Multiple pregnancies: In cases of twins, triplets, or more, where the risk of early labour is higher.

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

The steroids are generally administered between 24 and 34 weeks of pregnancy for maximum efficacy. (Royal College of Obstetricians and Gynaecologists, 2023)

2. How Antenatal Steroids Are Administered

Antenatal steroids are administered as injections, typically in two doses 24 hours apart. These injections are usually given in a hospital setting, under the supervision of healthcare professionals. The steroids quickly cross the placenta, affecting the fetus and helping to accelerate the maturation of its lungs and other vital organs.

Once administered, the effects of antenatal steroids are typically seen within 48 hours, and the benefits can last up to seven days. During this time, the baby’s chances of surviving and thriving after preterm birth are significantly improved. (NHS, 2023)

Antenatal Care: Comprehensive Support for Pregnant Women

1. A Holistic Approach to Antenatal Care

While antenatal steroids are a critical part of pregnancy care, they are just one element of a comprehensive antenatal care plan. Routine antenatal appointments, antenatal scans, and antenatal checkups are essential in ensuring that both mother and baby remain healthy throughout pregnancy. Regular visits to the antenatal clinic provide the opportunity for healthcare providers to monitor the pregnancy, assess any risks, and make informed decisions regarding treatments like antenatal steroids.

In addition to medical care, a holistic approach to antenatal care includes the mental and emotional well-being of the mother. Expectant mothers are encouraged to participate in antenatal yoga and prenatal fitness classes, which can help reduce stress and improve physical health during pregnancy. Practices like prenatal massage also offer significant benefits for relaxation and pain relief.

By focusing on both the physical and emotional aspects of antenatal care, expectant mothers can feel more supported and prepared for the challenges of pregnancy and childbirth. (My Expert Midwife, 2023)

2. The Role of Antenatal Education

A key component of antenatal care is education. Antenatal classes provide valuable information on a wide range of topics, including childbirth, breastfeeding, and neonatal care. These classes also offer an opportunity for expectant parents to learn more about antenatal steroids and other treatments available for preterm birth prevention.

Participating in antenatal education ensures that parents are well-informed and empowered to make the best decisions for their health and their baby’s health. (NHS, 2023)

Conclusion

Antenatal steroids are a vital treatment for preventing complications associated with preterm birth. By promoting lung development and reducing the incidence of respiratory distress syndrome (RDS) and other preterm birth-related complications, these steroids significantly improve neonatal health outcomes. While there are potential risks to both the mother and baby, these are generally minimal and far outweighed by the benefits of antenatal steroids.

As part of a comprehensive antenatal care plan, antenatal steroids help ensure that preterm infants have the best possible start in life. Expectant parents who are at risk of preterm birth should work closely with their healthcare providers to understand how antenatal steroids fit into their overall pregnancy care plan, as well as how other aspects of antenatal support, such as prenatal yoga, antenatal checkups, and antenatal education, can contribute to a healthier pregnancy and childbirth experience.