Who Should Get Steroids in Pregnancy to Mature the Fetal Lungs?

Patients who are either having an indicated pre-term delivery for maternal or fetal indications or those patients who are in preterm labor are candidates for antenatal steroids to mature the fetal lungs.

In the past, steroids were indicated between 24 and 34 weeks of gestation. One course of steroids is given, which consists of one dose of IM betamethasone followed by another dose 24 hours later. Ideally, delivery should be attempted to be postponed for 48 hours while the steroids take effect, but some studies show that even 6 hours of steroids can have beneficial effects on fetal lung maturity.

Newer guidelines have extended the window of steroid use beyond 34 weeks.

Are there new guidelines for giving steroids even later in pregnancy?

Expanded guidelines have recently been introduced to give antenatal steroids for indicated or spontaneous preterm delivery prior to 37 weeks. There is new data to suggest that “late preterm delivery” between 34 and 37 weeks has morbidity for the infant, and we can ameliorate some of that morbidity by extending the interval of steroid administration to 36 weeks and 5 days.

There are certain restrictions that would obviate later use of steroids, but it is important for you to know about the extended window and ask your doctor about your specific situation if you believe you are at high risk of delivering prior to 37 weeks.

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