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
Certainty of evidence
Low
Either intramuscular (IM) dexamethasone or IM betamethasone (total 24 mg in divided doses) is recommended as the antenatal corticosteroid of choice when preterm birth is imminent.
Notes and Remarks
- 1.The GDG noted that there is no conclusive evidence on the comparative efficacy of dexamethasone and betamethasone that would support a recommendation of one over the other. The group acknowledged that dexamethasone has an advantage over betamethasone in terms of lower cost and wider availability, and it is currently listed for use in pregnant women on the WHO Essential Medicine List and in WHO’s Managing complications in pregnancy and childbirth: a guide for midwives and doctors
- 2.The GDG acknowledged that the doses and regimens for both dexamethasone and betamethasone varied slightly across trials comparing the two, but noted that in the majority a total steroid dose of 24 mg was administered in divided doses 12 hours or 24 hours apart. Four doses of dexamethasone 6 mg IM 12 hours apart or two doses of betamethasone 12 mg IM 24 hours apart were the preferred choice in most of the studies. When deciding on the dosing frequency, consideration should be given to the likely timing of preterm birth to ensure that the woman completes the total dose of steroid or receives a substantial amount of the total dose before birth. Although there were no data on women’s satisfaction, women are likely to prefer fewer injections.
- 3.The GDG reviewed the important differences in the type and preparation of steroids across settings and emphasized that local protocols on the type and dosing regimen of antenatal steroid should be informed by the preparations that are readily available in the setting. This will not only encourage uptake and ease their use by health-care providers but also avoid incorrect dosing and wastage of resources.
- 4.The panel felt there might be important differences in pharmacological properties of dexamethasone and betamethasone dosage regimens and therefore considered this as a research priority