When Are Antenatal Steroids Recommended During Pregnancy?

Introduction

Preterm birth, defined as giving birth before 37 weeks of pregnancy, presents a significant risk to both the mother and baby. One of the most critical interventions for pregnant women at risk of preterm birth is the administration of antenatal steroids. These corticosteroids, typically betamethasone or dexamethasone, are administered to accelerate the development of the fetus’s lungs and other essential organs. The goal is to reduce the risks associated with preterm birth, particularly respiratory issues that are common in premature infants.

In this article, we will explore when antenatal steroids are recommended during pregnancy, why they are used, how they work, and the benefits they offer for both mothers and babies. We will also highlight the importance of antenatal care, antenatal checkups, and antenatal education in managing pregnancies at risk of preterm birth.

What Are Antenatal Steroids?

Antenatal steroids are synthetic corticosteroids, usually betamethasone or dexamethasone, that are given to pregnant women at risk of preterm labour. Their primary purpose is to promote the maturation of the fetus’s lungs, particularly in premature babies, as underdeveloped lungs are a leading cause of preterm birth-related complications.

These steroids are administered in the form of injections, with two doses typically given 24 hours apart. The steroids cross the placenta and encourage the fetal organs, especially the lungs, to mature faster, reducing the risks of respiratory distress syndrome (RDS) and other complications associated with prematurity.

The most significant benefit of antenatal steroids is their effect on lung development, which helps preterm infants breathe more easily after birth. This intervention has been proven to reduce mortality rates and improve long-term health outcomes for preterm infants.

Why Are Antenatal Steroids Used in Preterm Birth?

1. Preventing Respiratory Distress Syndrome (RDS)

The primary reason for administering antenatal steroids is to reduce the incidence of respiratory distress syndrome (RDS) in preterm infants. RDS occurs when a baby’s lungs are not developed enough to produce sufficient surfactant, a substance that keeps the lungs inflated and allows for effective breathing. Without enough surfactant, the lungs collapse, causing difficulty breathing.

Antenatal steroids significantly enhance the production of surfactant in the fetus’s lungs. As a result, babies born prematurely who have received these steroids are less likely to develop RDS and are better able to breathe on their own without the need for mechanical ventilation. Studies show that antenatal steroids reduce the incidence of RDS by as much as 50%, leading to a marked improvement in the survival rate of preterm infants. (World Health Organization, 2023)

2. Reducing Other Preterm Birth Complications

In addition to improving lung function, antenatal steroids help reduce the risk of other complications associated with preterm birth, including:

Intraventricular haemorrhage (IVH): A condition where bleeding occurs in the brain, often affecting premature babies.

Necrotising enterocolitis (NEC): A severe gastrointestinal condition that affects premature infants.

Patent ductus arteriosus (PDA): A heart defect commonly seen in preterm babies.

By promoting the maturation of various fetal organs, including the brain, intestines, and heart, antenatal steroids reduce the occurrence and severity of these conditions. Babies exposed to antenatal steroids are less likely to require extensive neonatal care, leading to shorter hospital stays and improved outcomes. (American Pregnancy Association, 2023)

3. Improving Long-Term Health Outcomes

The benefits of antenatal steroids extend beyond the immediate neonatal period. Studies have shown that babies who receive antenatal steroids have better long-term health outcomes, including improved cognitive and motor development, fewer behavioural problems, and a lower risk of developmental delays.

For instance, infants who received antenatal steroids were less likely to experience conditions such as cerebral palsy, learning disabilities, and long-term respiratory issues. These long-term benefits highlight the importance of antenatal steroids in ensuring not just the survival but also the thriving of preterm babies. (Mayo Clinic, 2023)

When Are Antenatal Steroids Recommended During Pregnancy?

1. Indications for Antenatal Steroids

Antenatal steroids are typically recommended for pregnant women who are at risk of preterm birth. The key indications for administering antenatal steroids include:

Threatened preterm labour: When labour begins before 34 weeks of pregnancy, especially if there are concerns that it could lead to preterm birth.

Multiple pregnancies: In the case of twins, triplets, or other multiples, where preterm birth is more common.

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

The administration of antenatal steroids is most effective when given between 24 and 34 weeks of gestation, as this is when the baby’s lungs are most susceptible to the benefits of steroid treatment. It is important that the timing of antenatal steroid administration is carefully considered by healthcare providers, as administering the steroids too early or too late may not provide the same benefits. (Royal College of Obstetricians and Gynaecologists, 2023)

2. Timing of Administration

The optimal timing for antenatal steroids is typically between 24 and 34 weeks of gestation, with the steroids being most effective within this window. If a woman is likely to deliver before 34 weeks, antenatal steroids should be given as soon as possible. The steroids are usually administered in two injections, 24 hours apart, and the effects begin within 24-48 hours.

If preterm birth occurs after 34 weeks, the benefits of antenatal steroids are generally less significant. This is because by this stage, the fetus’s lungs are typically more developed, and the risk of RDS is reduced. (National Institutes of Health, 2023)

Potential Risks and Side Effects of Antenatal Steroids

1. Risks for the Mother

While antenatal steroids are generally safe, there are some potential risks for 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 lead to complications such as hyperglycaemia, but these effects are typically short-lived and reversible once the steroids are discontinued.

Additionally, antenatal steroids can suppress the immune system, making the mother more vulnerable to infections. However, these side effects are generally mild and are managed by healthcare professionals during treatment. (American College of Obstetricians and Gynecologists, 2023)

2. Risks for 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 life. However, this risk remains relatively low, and the overall evidence suggests that the benefits of antenatal steroids far outweigh these potential risks.

There is also some evidence that antenatal steroids may have an impact on the child’s behaviour, including increased risk of hyperactivity. However, the research is mixed, and many studies show no significant long-term effects on children exposed to antenatal steroids. (Mayo Clinic, 2023)

The Importance of Antenatal Care in Preterm Birth Prevention

1. A Holistic Approach to Antenatal Care

While antenatal steroids are a key part of preventing complications in preterm infants, they are only one element of a comprehensive antenatal care plan. Regular antenatal appointments, antenatal scans, and antenatal checkups are essential to ensure both the mother and baby remain healthy throughout pregnancy.

During these antenatal checkups, healthcare providers can assess the risk of preterm labour, offer appropriate treatments like antenatal steroids, and provide vital support to the mother. Antenatal care also includes antenatal vitamins to support fetal growth and development, as well as advice on pregnancy yoga, prenatal massage, and other practices to maintain physical and mental well-being during pregnancy. (My Expert Midwife, 2023)

2. Antenatal Education and Support

Expectant parents can also benefit from antenatal education, which provides information about childbirth, neonatal care, and managing preterm birth risks. By attending antenatal classes, parents can learn more about the importance of antenatal steroids, prenatal care, and pregnancy yoga. These classes also offer a valuable opportunity to connect with other expectant parents and receive emotional support throughout the pregnancy.

Conclusion

Antenatal steroids are a crucial tool in managing preterm birth and improving neonatal outcomes, particularly by promoting lung development and preventing respiratory distress syndrome (RDS). While there are some risks associated with their use, the benefits far outweigh the potential side effects, especially when administered in the optimal time frame and with appropriate antenatal care. Expectant parents at risk of preterm birth should work closely with their healthcare providers to understand the role of antenatal steroids and ensure the best possible outcomes for their babies.