New Evidence Available
Updated Recommendation
A new evidence synthesis was published:2022, WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes.
View latest version (2022)Bibliographic Info
GuidelineWHO recommendations on interventions to improve preterm birth outcomes
Year of Publication2015
Issuing InstitutionWorld Health Organization
Recommendation
Status
Retired
Recommended in favor
Strong
Antenatal corticosteroid therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met:
. gestational age assessment can be accurately undertaken; . preterm birth is considered imminent; there is no clinical evidence of maternal infection; adequate childbirth care is available (including the capacity to recognize and safely manage preterm labour and birth); . the preterm newborn can receive adequate care if needed (including resuscitation, thermal care, feeding support, infection treatment and safe oxygen use)
Notes and Remarks
- 1.This recommendation applies to all other recommendations relating to the use of antenatal corticosteroids in this guideline
- 2.The recommendation is largely based on evidence derived from settings where the certainty of gestational age estimation is high. Therefore, accurate and standardized gestational age assessment (ideally from first trimester ultrasound) is essential to ensure that all eligible mothers receive corticosteroids while avoiding unnecessary treatment of ineligible mothers. Antenatal corticosteroid should not be routinely administered in situations where the gestational age cannot be confirmed, particularly when gestational age is suspected to be more than 34 weeks, as the risk of harm may outweigh the benefits if mature fetuses are exposed to corticosteroid in-utero.
- 3.Due consideration should be given to local limits of fetal viability when determining the lowest limit of gestational age when antenatal steroids should be administered, including reference to local data on newborn survival and morbidity. The GDG noted that the probability of survival without residual morbidity (“intact survival”) at < 24 weeks is low, even in high-resource settings.
- 4.The GDG acknowledged that the conditions listed above may not be operationalized in a standard and consistent manner across settings. Identifying the most critical and essential preconditions to achieve clinical benefits from antenatal corticosteroid is uncertain and would benefit from further research. In setting these preconditions, the panel’s emphasis was on minimizing harm to the mother and the baby.
- 5.An appropriate standard of childbirth care should be available to the mother in a facility that has a team of health-care providers competent in recognizing and safely managing preterm labour and imminent preterm birth. Safe care during labour and childbirth requires close monitoring of the mother and fetus to identify and appropriately manage complications, such as maternal infection and fetal hypoxia.
- 6.Essential and special care for the management of preterm newborns should be available to prevent or address any newborn complications related to prematurity or otherwise.
- 7.The GDG made a strong recommendation, having placed its emphasis on: the benefits to the preterm infants, in terms of reducing early morbidity and mortality outcomes; the low-cost and wide availability of corticosteroid globally; the feasibility of implementing the intervention; and the potential impact on health-care resource use across settings.