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By Anthony J. Brown, MD

WESTPORT, CT (Reuters Health) – While weekly courses of corticosteroids are often given to women at risk of preterm delivery, they do not reduce composite neonatal morbidity any more than single courses do, according to a report published in the October 3rd issue of the Journal of the American Medical Association.

Dr. Debra A. Guinn from the Denver Health Medical Center and colleagues studied 502 pregnant women between 24 and 32 weeks' gestation who were at high risk of preterm delivery. All women received a single course of antenatal corticosteroids and were then randomized to receive weekly corticosteroid or placebo treatment until 34 weeks' gestation or delivery, whichever came first.

Composite neonatal morbidity, the main outcome measure, included severe respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular hemorrhage, periventricular leukomalacia, proven sepsis, necrotizing enterocolitis, or perinatal death.

The composite neonatal morbidity rates in the single and weekly groups were 28.0% and 22.5%, respectively, the authors note. Group assignment and number of treatment courses were not associated with a reduction in composite morbidity.

"This is the first randomized trial to show that weekly courses are not warranted. The other studies that have shown this have been historical case controls," Dr. Guinn told Reuters Health.

"When we first began this study in 1996, the standard of care was to give weekly courses of steroids," Dr. Guinn said. "However, in the last couple of years, this practice has changed and more and more physicians are giving single courses," she added.

"My hope is that patients will now have the opportunity to provide informed consent regarding whether they want to receive repeat courses of antenatal steroids," Dr. Guinn noted. "I'm not convinced that informed consent was being offered in the past. I think patients were simply being told, 'here is your [dose of] steroids, you need them.'"

"At the very least, I hope that physicians will see that there are potential pluses and minuses to weekly courses," Dr. Guinn added. However, "the pluses are probably minimal and the potential for harm is definitely there," she added.

"In showing a lack of benefit in composite (short-term) morbidity, the study contributes to concerns that multiple courses of antenatal corticosteroids, particularly when administered weekly for three or more times, may have negative effects on long-term neurodevelopmental outcomes," Dr. Edward E. Lawson, from the Johns Hopkins School of Medicine in Baltimore, comments in a related editorial.

However, Dr. Lawson notes, "the pendulum on this issue should not swing back so far that ongoing studies evaluating longer-term outcomes are stopped."