Repeat prenatal low-dose corticosteroids probably safe

Repeat doses of prenatal corticosteroids do not significantly increase the risks for major adverse neurodevelopmental outcomes or delayed growth in children, but higher doses may be linked to an increased rate of cerebral palsy (CP), according to two studies published in the Sept. 20 issue of the New England Journal of Medicine.

Caroline Crowther, of the University of Adelaide in North Adelaide, Australia, and colleagues assessed 1,085 children at age 2 years whose mothers had been randomly assigned to receive repeat injections of prenatal corticosteroid or placebo. The investigators found that repeat corticosteroid treatment did not affect survival free of major neurosensory disability or growth.

Ronald Wapner, MD, of Columbia University in New York City, and colleagues assessed 556 children at ages 2 to 3 years whose mothers received repeat prenatal injections of corticosteroids or placebo. They found no significant group differences in Bayley Scales of Infant Development results or anthropometric measurements but identified six cases (2.9%) of CP in the repeat-corticosteroid group compared with one case (0.5%) in the placebo group.

"Further study of neurodevelopmental performance in school-age children is warranted, including the possible increased risk of cerebral palsy," states the author of an accompanying editorial. "Pending the availability of such data, if a decision is made to give repeat courses of corticosteroids, it may be prudent to consider the use of lower doses."

Crowther CA, Doyle LW, Haslam RR, et al. Outcomes at 2 years of age after repeat doses of antenatal corticosteroids. N Engl J Med. 2007;357:1179-1189.

Wapner RJ, Sorokin Y, Mele L, et al. Long-term outcomes after repeat doses of antenatal corticosteroids. N Engl J Med. 2007;357:1190-1198.