Guideline

WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes.

Year of Publication

2022

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

11 included recommendations

Antenatal corticosteroid therapy is recommended for women with a high likelihood of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met: Gestational age assessment can be accurately undertaken; There is a high likelihood of preterm birth within 7 days of starting therapy; There is no clinical evidence of maternal infection; Adequate childbirth care is available (including capacity to recognize and safely manage preterm labour and birth; The preterm newborn can receive adequate care (including resuscitation, kangaroo mother care, thermal care, feeding support, infection treatment and respiratory support including continuous positive airway pressure [CPAP] as needed)

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

Antenatal corticosteroid therapy should be administered to women with a high likelihood of giving birth preterm in the next 7 days, even if it is anticipated that the full course of corticosteroids may not be completed.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Low

Antenatal corticosteroid therapy is recommended for women with a high likelihood of preterm birth, irrespective of whether single or multiple birth is anticipated.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Low

Antenatal corticosteroid therapy is recommended for women with preterm prelabour rupture of membranes and no clinical signs of infection

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Low

Antenatal corticosteroid therapy is not recommended for women with chorioamnionitis who are likely to give birth preterm.

Status

Maintained

Not recommended

Certainty of evidence

Very low

Antenatal corticosteroid therapy is not recommended for women undergoing planned caesarean section at 34 weeks 0 days to 36 weeks 6 days

Status

Maintained

Not recommended

Certainty of evidence

Very low

Antenatal corticosteroid therapy is recommended for women with hypertensive disorders in pregnancy who have a high likelihood of preterm birth

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Moderate

Antenatal corticosteroid therapy is recommended for women with a high likelihood of preterm birth of a growth-restricted fetus

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Very low

Antenatal corticosteroid therapy is recommended for women with pre-gestational and gestational diabetes when there is a high likelihood of preterm birth, and this should be accompanied by interventions to optimize maternal blood glucose control.

Status

Maintained

Context specific recommendation

Only in specific contexts

Certainty of evidence

Very low

Either intramuscular (IM) dexamethasone or IM betamethasone (total 24 mg in divided doses) is recommended as the antenatal corticosteroid of choice

Status

Maintained

Recommended

Certainty of evidence

Low

A single repeat course of antenatal corticosteroids is recommended for women who have received a single course of antenatal corticosteroids at least 7 days prior and, on clinical assessment, have a high likelihood of giving birth preterm in the next 7 days

Status

Maintained

Recommended

Certainty of evidence

Low