The Role of Antenatal Steroids in Preterm Birth Management

Introduction

Preterm birth is a leading cause of neonatal morbidity and mortality worldwide, and its management has become a critical focus in modern obstetrics. One of the most important interventions in managing preterm birth is the use of antenatal steroids. These steroids are administered to women at risk of preterm delivery to help accelerate fetal lung development and reduce the incidence of respiratory distress syndrome (RDS) and other complications associated with prematurity.

This article explores the role of antenatal steroids in the management of preterm birth, examining their benefits, potential risks, the science behind their use, and how they fit into broader prenatal care practices. The article also highlights how antenatal appointments, antenatal checkups, and other aspects of antenatal care contribute to improving maternal and neonatal outcomes.

What Are Antenatal Steroids?

1. Definition and Function

Antenatal steroids typically refer to corticosteroids such as dexamethasone and betamethasone. These steroids are administered to pregnant women at risk of preterm labour, typically between 24 and 34 weeks of gestation. The primary function of antenatal steroids is to stimulate fetal lung maturation, particularly the production of surfactant, a substance that helps keep the lungs inflated after birth. Surfactant deficiency is a major cause of respiratory distress syndrome in preterm infants. By promoting the production of surfactant and accelerating other organ development, antenatal steroids significantly improve the likelihood of a healthy outcome for babies born prematurely.

A key advantage of antenatal steroids is their ability to prepare the lungs for breathing air after birth. The treatment typically involves two injections of betamethasone or dexamethasone, given 24 hours apart, with effects seen within 48 hours of administration. (American College of Obstetricians and Gynecologists, 2023)

The Benefits of Antenatal Steroids

1. Prevention of Respiratory Distress Syndrome (RDS)

One of the most significant benefits of antenatal steroids is their ability to prevent or reduce the severity of respiratory distress syndrome (RDS), which occurs when the lungs are not fully developed in premature infants. RDS can lead to significant breathing difficulties and, in severe cases, the need for mechanical ventilation.

By promoting lung maturation, antenatal steroids improve the production of surfactant, a protein critical for the proper functioning of the lungs. This reduces the likelihood that a preterm infant will experience RDS, a major cause of neonatal morbidity. Studies have shown that the use of antenatal steroids can reduce the incidence of RDS by up to 50%, significantly improving neonatal survival rates. (World Health Organization, 2023)

2. Reduction in Other Preterm Birth Complications

In addition to improving lung function, antenatal steroids are also known to reduce the incidence of other complications associated with preterm birth, such as:

Intraventricular haemorrhage (IVH): Bleeding in the brain that is common in extremely premature infants.

Necrotising enterocolitis (NEC): A serious intestinal condition more common in preterm babies.

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

By enhancing fetal organ development, particularly the brain and intestines, antenatal steroids play a crucial role in preventing these life-threatening conditions. (Royal College of Obstetricians and Gynaecologists, 2023)

3. Improved Long-Term Outcomes

The benefits of antenatal steroids extend beyond the neonatal period. Research suggests that babies who receive antenatal steroids show improved cognitive and motor development. While the immediate effects are related to lung and organ maturation, studies indicate that infants who are treated with antenatal steroids have better developmental outcomes in later years, such as fewer behavioural issues, higher IQ scores, and lower rates of cerebral palsy. These long-term benefits make antenatal steroids an essential treatment in modern preterm birth management. (Mayo Clinic, 2023)

Risks and Considerations of Antenatal Steroids

1. Potential Risks to the Baby

While the benefits of antenatal steroids are well-established, they are not without risks. Some studies have raised concerns about the potential long-term effects on infants who were exposed to antenatal steroids. These risks include:

Increased risk of asthma or wheezing: There is some evidence to suggest that babies born after antenatal steroid exposure may have an increased risk of developing asthma or wheezing later in childhood, although the risk is generally small and the benefits outweigh this potential concern.

Developmental issues: Some studies have linked antenatal steroid use to behavioural changes and developmental delays, though these effects are minor and not consistently observed.

It is important to note that the potential risks are generally outweighed by the immediate benefits, especially in preterm infants, where the chance of survival and long-term health improves significantly. (American Pregnancy Association, 2023)

2. Potential Risks to the Mother

In addition to the effects on the baby, there are some risks for the mother as well. Antenatal steroids can temporarily raise blood sugar levels, which may be a concern for mothers with gestational diabetes. Additionally, corticosteroids may suppress the immune system, increasing the risk of infections in certain cases. However, these side effects are typically short-lived, and the benefits of antenatal steroids often far outweigh the risks. (National Institutes of Health, 2023)

When Are Antenatal Steroids Used?

1. Indications for Administration

Antenatal steroids are administered to women at risk of delivering prematurely. The typical indications for administering antenatal steroids include:

Threatened preterm labour: When a woman goes into labour before 34 weeks of pregnancy, and there is a high likelihood of preterm birth.

Multiple pregnancies: In cases of twins, triplets, or more, where the risk of premature delivery is increased.

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

Antenatal steroids are typically recommended for women between 24 and 34 weeks of gestation, as this is when they are most effective in promoting lung development and reducing complications associated with preterm birth. (Royal College of Obstetricians and Gynaecologists, 2023)

How Antenatal Steroids Fit into Antenatal Care

1. The Role of Antenatal Appointments

Antenatal steroids are typically administered after careful monitoring and diagnosis by healthcare professionals. Antenatal appointments and antenatal checkups play a critical role in identifying women at risk for preterm birth and ensuring they receive timely treatment. Routine antenatal scans help healthcare providers assess the baby’s growth and development, while antenatal appointments ensure the mother’s health is closely monitored.

By attending antenatal clinic visits, expectant mothers can receive the necessary care and support to manage preterm labour and reduce the risk of complications. It is during these appointments that doctors will assess the necessity for antenatal steroids and other treatments. (NHS, 2023)

2. A Holistic Approach to Pregnancy Care

In addition to antenatal steroids, a holistic approach to pregnancy care is essential. Antenatal vitamins, prenatal yoga, and antenatal support all contribute to improving maternal and fetal health. Yoga during pregnancy and antenatal massage are proven to alleviate pregnancy discomforts such as back pain and swelling, while promoting relaxation. These wellness practices, combined with antenatal steroids, create a comprehensive care plan for at-risk pregnancies.

Conclusion

Antenatal steroids are a vital tool in managing preterm birth, offering significant benefits for both mothers and babies. By promoting lung development and reducing the risk of respiratory complications and other preterm birth-related issues, these steroids have revolutionised the care of premature infants. However, like all medical interventions, antenatal steroids come with potential risks that must be carefully weighed by healthcare providers and expectant mothers.

By ensuring timely administration and integrating other aspects of antenatal care, such as antenatal yoga, prenatal massage, and regular antenatal checkups, antenatal steroids provide a life-saving solution for many babies born prematurely.