Editing Preterm birth (section)

===Steroids===
Severely premature infants may have underdeveloped lungs because they are not yet producing their own [[pulmonary surfactant|surfactant]]. This can lead directly to [[Infant respiratory distress syndrome|respiratory distress syndrome]], also called hyaline membrane disease, in the neonate. To try to reduce the risk of this outcome, pregnant mothers with threatened premature delivery prior to 34 weeks are often administered at least one course of [[glucocorticoids]], an [[antenatal steroid]] that crosses the placental barrier and stimulates the production of surfactant in the lungs of the baby.<ref name=ACOG2016/> Steroid use up to 37 weeks is also recommended by the [[American Congress of Obstetricians and Gynecologists]].<ref name=ACOG2016/> Typical glucocorticoids that would be administered in this context are [[betamethasone]] or [[dexamethasone]], often when the pregnancy has reached [[Fetal viability|viability]] at 23 weeks.{{Citation needed|date=May 2023}}

In cases where premature birth is imminent, a second "rescue" course of steroids may be administered 12 to 24 hours before the anticipated birth. There are still some concerns about the efficacy and side effects of a second course of steroids, but the consequences of RDS are so severe that a second course is often viewed as worth the risk. A 2015 [[Cochrane (organisation)|Cochrane]] review (updated in 2022) supports the use of repeat dose(s) of prenatal corticosteroids for women still at risk of preterm birth seven days or more after an initial course.<ref>{{cite journal | vauthors = Walters A, McKinlay C, Middleton P, Harding JE, Crowther CA | title = Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 4 | pages = CD003935 | date = April 2022 | pmid = 35377461 | pmc = 8978608 | doi = 10.1002/14651858.CD003935.pub5 }}</ref>

A Cochrane review from 2020 recommends the use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. Treatment with antenatal corticosteroids reduces the risk of perinatal death, neonatal death and respiratory distress syndrome and probably reduces the risk of IVH.<ref>{{cite journal | vauthors = McGoldrick E, Stewart F, Parker R, Dalziel SR | title = Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD004454 | date = December 2020 | pmid = 33368142 | pmc = 8094626 | doi = 10.1002/14651858.CD004454.pub4 | publication-date = Dec 25, 2020 }}</ref>

Concerns about adverse effects of prenatal corticosteroids include increased risk for maternal infection, difficulty with diabetic control, and possible long-term effects on neurodevelopmental outcomes for the infants. There is ongoing discussion about when steroids should be given (i.e. only antenatally or postnatally too) and for how long (i.e. single course or repeated administration). Despite these unknowns, there is a consensus that the benefits of a single course of prenatal glucocorticosteroids vastly outweigh the potential risks.<ref>{{cite web |url=https://consensus.nih.gov/1994/1994AntenatalSteroidPerinatal095html.htm |title=The National Institutes of Health (NIH) Consensus Development Program: The Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes |access-date=2017-07-18 |url-status=live |archive-url=https://web.archive.org/web/20170709174327/https://consensus.nih.gov/1994/1994antenatalsteroidperinatal095html.htm |archive-date=9 July 2017}}</ref><ref>{{cite web |url=https://consensus.nih.gov/2000/2000AntenatalCorticosteroidsRevisted112html.htm |title=The National Institutes of Health (NIH) Consensus Development Program: Antenatal Corticosteroids Revisited: Repeat Courses |access-date=2017-07-18 |url-status=live |archive-url=https://web.archive.org/web/20170118011125/https://consensus.nih.gov/2000/2000AntenatalCorticosteroidsRevisted112html.htm |archive-date=18 January 2017}}</ref><ref name="pmid28786098">{{cite journal | vauthors = Shepherd E, Salam RA, Middleton P, Makrides M, McIntyre S, Badawi N, Crowther CA | title = Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 8 | pages = CD012077 | date = August 2017 | pmid = 28786098 | pmc = 6483544 | doi = 10.1002/14651858.CD012077.pub2 }}</ref>