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
Very low
Antenatal corticosteroid therapy is recommended for women with pre-gestational and gestational diabetes who are at risk of imminent preterm birth, and this should be accompanied by interventions to optimize maternal blood glucose control
Notes and Remarks
- 1.The GDG acknowledged the paucity of evidence on the benefits of antenatal corticosteroid in this subgroup of women. However, the group placed its emphasis on the overall benefits of antenatal steroid in preterm, the potential benefits in terms of reducing the higher risk of newborn respiratory morbidity posed by maternal diabetes, and the potential impact on overall newborn survival, and therefore made a strong recommendation.
- 2.The group considered the concern about the maternal hyperglycaemic effect of antenatal corticosteroids, but agreed that it was insufficient to counterbalance the potential benefits for the baby if appropriate measures are taken to ensure glycaemic control.
- 3.Clinicians should ensure strict control of maternal blood glucose prior to and/or during pregnancy to reduce the risk of newborn respiratory distress syndrome.
- 4.Delay in fetal lung maturity is generally more frequent in pregnant diabetic women compared with the general obstetric population. Therefore, in pregnant women with poorly controlled diabetes, the use of corticosteroids should also be considered at > 34 weeks of gestation if there is laboratory evidence of fetal lung immaturity.