Antenatal Glucocorticoids Prior to Cesarean Delivery at Term

Abstract

Administration of glucocorticoids to pregnant women to accelerate fetal lung maturation prior to preterm birth is one of the most effective interventions in perinatal medicine. Its success led to the evaluation of glucocorticoid administration prior to prelabor cesarean delivery between 37 weeks 0 days and 38 weeks 6 days of gestational age. The Antenatal Steroids for Term Elective Caesarean Section (ASTECS) trial demonstrated that antenatal glucocorticoids reduced short-term respiratory morbidity.¹ Based on this evidence, the Royal College of Obstetricians and Gynaecologists in the United Kingdom recommended antenatal glucocorticoids prior to all planned cesarean births before 39 weeks.² Administration of antenatal glucocorticoids has become common practice in the United Kingdom and elsewhere. The long-term follow-up of the ASTECS trial by Stutchfield et al³ has recently been published. The authors concluded that “antenatal betamethasone did not result in any adverse outcomes… it should be considered for elective cesarean section at 37-38 weeks of gestation.”^3(pF195) However, we believe that the long-term outcome data and the known pharmacologic effects of high doses of synthetic glucocorticoids indicate that this intervention should not be routinely recommended.