Introduction
Pregnancy is a crucial phase in the baby's development in the womb, and it is often associated with certain complications that can endanger the baby’s life and, at times, bring in grave pregnancy outcomes. Preterm birth is one such condition, where the baby gets delivered much before the estimated delivery date, which results in a premature baby. Prematurely born babies lack structural and functional developments intended in a newborn baby.
The 39 weeks of gestation is estimated to be the anticipated duration of a normal pregnancy. In preterm birth, the delivery happens before pregnancy attains 37 weeks. Severe prematurity makes it challenging for the baby to thrive. It is a globally recognized pregnancy complication that is critical to infant (newborn) mortality.
Certain maternal conditions enhance the susceptibility to premature childbirth. Technological innovations and advancements in the fetus (baby in the womb) monitoring approaches often aid in identifying the likelihood of a preterm birth beforehand.
What Is Antenatal Corticosteroid Therapy?
Antenatal corticosteroid therapy is a promising therapeutic intervention advised for expectant mothers who are likely to deliver a premature baby before attaining the estimated delivery date. Following rigorous research and scientific explorations, it was found that by administering antenatal corticosteroids, the devastating outcomes concerning a premature delivery can be checked to an extent. The treatment intervention's availability and affordability help gain global attention and is thus one of the frequently proposed therapeutic interventions.
Antenatal corticosteroid therapy enhances and facilitates the maturation and development of life-sustaining organs in the fetus (baby in the womb). Dexamethasone and Betamethasone are the two routinely preferred corticosteroids for antenatal corticosteroid therapy in expectant women. These medicines are introduced into the mother’s body through injections; intramuscular is the advised route of administration, where the medicine is shot up into the muscle cells, which are then uptaken into the circulating blood. These medicines can cut across the placental barrier, thereby gaining access to act on the fetus. Antenatal corticosteroid therapy limits the need for intensive care and ventilator support for preterm babies.
What Are the Considerations Associated With the Efficacy and Safety of Antenatal Corticosteroid Therapy?
Antenatal corticosteroid therapy is reported to be highly efficacious with extensive application in the perinatal medicine field. Dexamethasone and Betamethasone are proportionate in their effectiveness and no studies proved the therapeutic benefit of one over the other. Both medicines work the same way and elicit similar body responses. Some of the efficacy considerations concerning the use of antenatal corticosteroids include the following:
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Antenatal corticosteroid therapy elicited a dramatic collapse in the death rate associated with premature birth. However, the optimum dosage for maximum effectiveness is yet to be figured out.
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Premature birth often results in immature lung and respiratory structures, precipitating breathing complications in respiratory distress syndrome (troubled and impaired breathing). It compromises oxygen intake, which necessitates immediate medical intervention. Antenatal corticosteroid therapy augments and facilitates lung development, thereby depreciating the possibility of breathing issues in prematurely born babies. However, no specific standard dosage regimen needs to be adhered to. Furthermore, the administration of Dexamethasone and Betamethasone is not authorized by the drug regulatory authority of the United States Food and Drug Administration (FDA), during the conception, which indicates a scope for potential harm.
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By employing antenatal corticosteroid therapy, other alarming health hazards precipitated by premature delivery can be effectively tackled. Necrotizing enterocolitis (stomach cells die out) and intraventricular hemorrhage (blood gathering within the brain space) are two grave conditions that develop due to early birth. Antenatal corticosteroid collapses the likelihood of necrotizing enterocolitis by facilitating intestinal maturation. Similarly, it potentiates blood vessel growth and tackles the susceptibility for intraventricular hemorrhage.
There are certain safety considerations concerning antenatal corticosteroid therapy. Some of them include the following:
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Since the FDA does not endorse antenatal corticosteroids in expectant women, it does not preclude the possibility of maternal or baby harm.
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Lack of information concerning the safer dose and duration of the therapy regimen often creates confusion regarding the optimum dose required to precipitate the desired outcome without paving the way for toxicity issues in the mother or baby.
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No appreciable data states the safest gestational period to carry out antenatal corticosteroid introduction into the maternal body. Similarly, the method of usage of antenatal corticosteroids exhibits regional variations and revisions.
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Antenatal corticosteroid therapy is not advised in expectant women suspected of having any form of active infection in their bodies. Corticosteroids collapse the maternal body's immune status upon administration, further deteriorating the immunity and allowing the infection to flourish.
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Before advising antenatal corticosteroid therapy, it is imperative to assess and analyze the suitability of the treatment intervention for that particular patient. Individualized assessment needs to be made to look for possible harmful effects.
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Antenatal corticosteroid therapy is recommended for enhancing pregnancy outcomes, particularly fetal health. However, it is obligatory to consider the impact of antenatal corticosteroid therapy on the expectant mother’s body. Studies have reported transient and persisting side effects on the maternal body following the therapy. Before proceeding with the therapy, comparative analysis should be conducted by evaluating the benefit-risk ratio associated with that particular case.
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The absence of strict guidelines concerning the choice of corticosteroids often makes it challenging for the doctor to evaluate the safety profile for the patients and the appropriate drug choice. The knowledge gap needs to be eliminated with the help of researchers and clinical trials to extend the scope of antenatal corticosteroid therapy.
Conclusion
Antenatal corticosteroid therapy using Dexamethasone or Betamethasone is a routinely adopted measure for checking various health complications that arise in response to preterm birth. The medicines are introduced into the expectant mother’s body, who is identified to deliver the baby prematurely before attaining the full term. A thorough assessment of the probability of preterm birth is imperative to check inadvertent steroid introduction into the maternal body.
Surveillance and monitoring of the mother and baby following antenatal corticosteroid therapy is often extensive and prolonged, which aids in detecting long-term and late-onset adverse effects. Though there are potent safety and efficacy considerations concerning antenatal corticosteroids, expectant women can make informed decisions with guidance and instructions from the concerned physicians. It often aids in saving the baby’s life when employed at the correct time. Thorough knowledge regarding patient choice is the essence of favorable treatment outcomes with negligible scope for adverse effects.
