No Raised Risk With Multiple Steroid Courses


Major Finding: Death or neurologic impairment at 18-24 months was just under 14% among the offspring of women at high risk for preterm birth, irrespective of whether they were given a single course or multiple courses of antenatal corticosteroids.

Data Source: The MACS trial of 1,858 women at high risk for preterm birth.

Disclosures: MACS was funded by the Canadian Institutes of Health Research. The authors disclosed no conflicts of interest.

CHICAGO — The risk of death or neurologic impairment was similar at 2 years after exposure to either single or multiple courses of antenatal corticosteroids, according to a follow-up analysis of data from the multicenter MACS trial.

“Continued follow-up of these children is important and necessary to determine if there are subtle effects of steroid exposure that only become evident in later years,” Dr. Elizabeth Asztalos said at the annual meeting of the Society of Maternal-Fetal Medicine.

The findings are encouraging as the same group previously reported that multiple courses of antenatal corticosteroids (ACS) given at 14-day intervals do not improve preterm birth outcomes and are associated with a significant decrease in weight, length, and head circumference at birth (Lancet 2008;372:2143-51). “Therefore, this treatment schedule is not recommended,” the authors wrote.

MACS, the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study, included women who were at high risk of preterm birth at 25-32 weeks' gestation. All of the women received an initial course of ACS. There were 1,858 women who were undelivered and remained at high risk at 14-21 days after the initial course of ACS. These women were randomized to either ACS or placebo given every 14 days until week 33 or delivery, whichever came first.

The secondary composite outcome of death or neurologic impairment was evaluated at 18-24 months. Neurologic impairment was defined as cerebral palsy or abnormal cognitive development defined by a Mental Development Index (MDI) score of less than 70 on the Bayley Scales of Infant Development–Second Edition.

Evaluations were conducted in 1,069 infants exposed to multiple courses of ACS and 1,035 infants exposed to placebo at a median of 22 months old.

The occurrence rate of the composite outcome was nearly identical—13.8% (148) of the ACS group and in 13.7% (142) of the placebo group, said Dr. Asztalos of the department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre in Toronto. Also, the components of the composite outcome were nearly identical—mortality (49 vs. 47), cerebral palsy (24 vs. 25), and cognitive impairment (86 vs. 84).

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