How Antenatal Steroids Improve Neonatal Health Outcomes

Introduction

Preterm birth remains a leading cause of neonatal morbidity and mortality globally. Advances in medical treatments, however, have helped improve survival rates and outcomes for preterm infants. Among these advancements, the use of antenatal steroids has proven to be one of the most effective interventions in prenatal care. Administered to women at risk of preterm labour, antenatal steroids accelerate the maturation of fetal organs, particularly the lungs, enhancing the baby’s chances of survival and reducing the risk of complications like respiratory distress syndrome (RDS).

In this article, we will explore the role of antenatal steroids in improving neonatal health outcomes, their benefits, potential risks, and how they fit into the broader context of antenatal care. We will also examine the evolution of pregnancy care and the importance of regular antenatal checkups to monitor at-risk pregnancies.

What Are Antenatal Steroids?

Antenatal steroids are corticosteroids, typically betamethasone or dexamethasone, that are administered to pregnant women at risk of preterm birth. These steroids stimulate the baby’s organs to mature more rapidly, particularly the lungs, which are often underdeveloped in preterm infants. Administering antenatal steroids has been shown to significantly reduce the incidence of complications like RDS, and improve overall neonatal outcomes.

The steroids are usually given in two injections over the course of 24 hours, and their effects are typically seen within 48 hours. They cross the placenta and promote the development of key organs, especially the lungs, liver, and intestines, which are critical for the infant’s survival and health.

The Benefits of Antenatal Steroids for Neonatal Health

1. Prevention of Respiratory Distress Syndrome (RDS)

The primary benefit of antenatal steroids is the prevention of respiratory distress syndrome (RDS), a condition that affects preterm infants due to insufficient lung development. RDS occurs when the lungs do not produce enough surfactant, a substance that helps keep the lungs inflated and allows for proper breathing.

Antenatal steroids promote the production of surfactant, which is crucial for lung function after birth. Studies have shown that babies who receive antenatal steroids are less likely to develop RDS or experience its severity. This reduces the need for mechanical ventilation and decreases the likelihood of long-term respiratory issues. The use of antenatal steroids has been found to reduce the incidence of RDS by up to 50%, drastically improving survival rates and long-term health for premature infants. (World Health Organization, 2023)

2. Reduced Incidence of Other Preterm Birth Complications

Beyond preventing RDS, antenatal steroids also reduce the risk of other common complications associated with preterm birth. These include:

Intraventricular haemorrhage (IVH): Bleeding in the brain that often occurs in premature infants.

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

Patent ductus arteriosus (PDA): An abnormal heart condition common in preterm babies.

The use of antenatal steroids has been shown to reduce the occurrence of these conditions, further improving neonatal outcomes. Babies who are administered antenatal steroids have a significantly lower risk of requiring extensive medical interventions in the neonatal period. (Royal College of Obstetricians and Gynaecologists, 2023)

3. Improved Long-Term Health Outcomes

One of the most remarkable aspects of antenatal steroids is their potential to improve long-term health outcomes for premature infants. Research has shown that antenatal steroids not only reduce the immediate risks of premature birth but also contribute to better development in the long term.

Infants who receive antenatal steroids have been found to have improved cognitive and motor development, fewer behavioural problems, and a lower risk of conditions such as cerebral palsy. This highlights the broader, lasting benefits of antenatal steroids beyond the immediate neonatal period, improving the quality of life for premature infants as they grow. (National Institutes of Health, 2023)

The Risks and Side Effects of Antenatal Steroids

1. Potential Risks to the Mother

While antenatal steroids are widely regarded as safe, there are some risks associated with their use. For mothers, antenatal steroids can temporarily elevate blood sugar levels, which is particularly concerning for those with gestational diabetes. Elevated blood sugar can lead to complications such as hyperglycaemia, but these effects are generally short-lived and reversible once the steroids are discontinued.

Additionally, antenatal steroids may suppress the immune system, increasing the risk of infections. However, these side effects are typically minimal and are outweighed by the significant benefits for the baby. Healthcare providers carefully monitor mothers who receive antenatal steroids to manage any potential complications. (American Pregnancy Association, 2023)

2. Potential Risks to the Baby

Although the immediate benefits of antenatal steroids for the baby are well established, there are some concerns regarding potential long-term effects. Studies have suggested that babies exposed to antenatal steroids may be at a slightly increased risk of developing asthma or wheezing later in life, though this risk is generally low.

Some research has also explored potential behavioural issues in children exposed to antenatal steroids during pregnancy, such as hyperactivity or learning difficulties. However, the overall evidence is mixed, and the long-term benefits of improved neonatal survival and development generally outweigh these risks. (Mayo Clinic, 2023)

When Are Antenatal Steroids Administered?

1. Indications for Antenatal Steroid Use

Antenatal steroids are typically administered to women who are at risk of delivering prematurely. The treatment is most effective when given between 24 and 34 weeks of gestation. The following situations are common indications for antenatal steroids:

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

Multiple pregnancies: In cases of twins or triplets, where preterm birth is more common.

Preterm premature rupture of membranes (PPROM): When a woman’s water breaks prematurely, increasing the risk of early labour.

The administration of antenatal steroids is typically followed by careful monitoring in antenatal clinics to ensure both the mother and baby’s health are closely tracked. (Royal College of Obstetricians and Gynaecologists, 2023)

2. Timing of Administration

The timing of antenatal steroid administration is crucial for its effectiveness. The ideal window for steroid administration is between 24 and 34 weeks of gestation, as this is when the baby’s lungs are most susceptible to the effects of the steroids. Administration of the steroids too early, or after 34 weeks, may not be as effective in promoting lung development.

Healthcare providers carefully assess the gestational age and risk factors before recommending antenatal steroids. For example, antenatal checkups and pregnancy scans can help determine the optimal timing for administration. (NHS, 2023)

Antenatal Care: A Holistic Approach to Pregnancy Health

1. Antenatal Support and Education

While antenatal steroids are an essential part of pregnancy care for women at risk of preterm birth, they are just one component of a comprehensive antenatal care plan. Routine antenatal appointments, antenatal scans, and antenatal education are equally important in ensuring both the mother’s and baby’s health.

Through antenatal education, expectant mothers gain vital information about prenatal care, antenatal appointments, and what to expect during childbirth. Participating in antenatal classes allows parents to learn about the importance of nutrition, exercise, and mental well-being during pregnancy. These education programmes also provide practical tips on managing stress, relaxation, and preparing for the arrival of a baby.

2. Fitness and Relaxation During Pregnancy

Maintaining a healthy pregnancy requires a balanced approach that includes antenatal fitness and relaxation techniques. Regular physical activity such as prenatal yoga helps promote physical strength and flexibility, reduces back pain, and prepares the body for the rigours of childbirth. Additionally, practices such as antenatal massage can help alleviate stress and promote relaxation during pregnancy, contributing to a more positive birth experience.

Women who receive comprehensive antenatal support, including exercise and mental wellness strategies, often report lower levels of anxiety and greater physical comfort during pregnancy. (My Expert Midwife, 2023)

Conclusion

Antenatal steroids are a critical tool in managing preterm birth, offering significant benefits for neonatal health. By accelerating lung development and reducing the risk of complications like respiratory distress syndrome, these steroids improve the chances of survival and long-term health for premature infants. Despite the potential risks, the benefits far outweigh these concerns, especially when steroids are administered at the right time and in conjunction with comprehensive antenatal care.

From antenatal yoga and prenatal massage to antenatal checkups and antenatal scans, modern pregnancy care focuses on supporting both the mother and baby throughout pregnancy. With continued advancements in antenatal support and treatment options, the outlook for preterm infants has greatly improved, helping more babies to thrive even when born prematurely.