Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in context
Summary: Background: Antenatal corticosteroids (ACS) are highly effective at improving outcomes for preterm newborns. Evidence suggests the benefits of ACS may vary with the time interval between administration-to-birth. However, the optimal ACS administration-to-birth interval is not yet known. In...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-04-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537023000937 |
| _version_ | 1797860172820905984 |
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| author | Annie R.A. McDougall Lily Aboud Tina Lavin Jenny Cao Gabrielle Dore Jen Ramson Olufemi T. Oladapo Joshua P. Vogel |
| author_facet | Annie R.A. McDougall Lily Aboud Tina Lavin Jenny Cao Gabrielle Dore Jen Ramson Olufemi T. Oladapo Joshua P. Vogel |
| author_sort | Annie R.A. McDougall |
| collection | DOAJ |
| description | Summary: Background: Antenatal corticosteroids (ACS) are highly effective at improving outcomes for preterm newborns. Evidence suggests the benefits of ACS may vary with the time interval between administration-to-birth. However, the optimal ACS administration-to-birth interval is not yet known. In this systematic review, we synthesised available evidence on the relationship between ACS administration-to-birth interval and maternal and newborn outcomes. Methods: This review was registered with PROSPERO (CRD42021253379). We searched Medline, Embase, CINAHL, Cochrane Library, Global Index Medicus on 11 Nov 2022 with no date or language restrictions. Randomised and non-randomised studies of pregnant women receiving ACS for preterm birth where maternal and newborn outcomes were reported for different administration-to-birth intervals were eligible. Eligibility screening, data extraction and risk of bias assessment were performed by two authors independently. Fetal and neonatal outcomes included perinatal and neonatal mortality, preterm birth-related morbidity outcomes and mean birthweight. Maternal outcomes included chorioamnionitis, maternal mortality, endometritis, and maternal intensive care unit admission. Findings: Ten trials (4592 women; 5018 neonates), 45 cohort studies (at least 22,992 women; 30,974 neonates) and two case–control studies (355 women; 360 neonates) met the eligibility criteria. Across studies, 37 different time interval combinations were identified. There was considerable heterogeneity in included administration-to-birth intervals and populations. The odds of neonatal mortality, respiratory distress syndrome and intraventricular haemorrhage were associated with the ACS administration-to-birth interval. However, the interval associated with the greatest improvements in newborn outcomes was not consistent across studies. No reliable data were available for maternal outcomes, though odds of chorioamnionitis might be associated with longer intervals. Intepretation: An optimal ACS administration-to-birth interval likely exists, however variations in study design limit identification of this interval from available evidence. Future research should consider advanced analysis techniques such as individual patient data meta-analysis to identify which ACS administration-to-birth intervals are most beneficial, and how these benefits can be optimised for women and newborns. Funding: This study was conducted with funding support from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), a co-sponsored programme executed by the World Health Organization. |
| first_indexed | 2024-04-09T21:42:14Z |
| format | Article |
| id | doaj.art-a0109ecb883846729c2cd02607e64ca2 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-09T21:42:14Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-a0109ecb883846729c2cd02607e64ca22023-03-26T05:18:51ZengElsevierEClinicalMedicine2589-53702023-04-0158101916Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in contextAnnie R.A. McDougall0Lily Aboud1Tina Lavin2Jenny Cao3Gabrielle Dore4Jen Ramson5Olufemi T. Oladapo6Joshua P. Vogel7Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Corresponding author.Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, AustraliaDepartment of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, SwitzerlandMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, AustraliaRoyal Brisbane and Women's Hospital, Brisbane, AustraliaMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, AustraliaDepartment of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, SwitzerlandMaternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, AustraliaSummary: Background: Antenatal corticosteroids (ACS) are highly effective at improving outcomes for preterm newborns. Evidence suggests the benefits of ACS may vary with the time interval between administration-to-birth. However, the optimal ACS administration-to-birth interval is not yet known. In this systematic review, we synthesised available evidence on the relationship between ACS administration-to-birth interval and maternal and newborn outcomes. Methods: This review was registered with PROSPERO (CRD42021253379). We searched Medline, Embase, CINAHL, Cochrane Library, Global Index Medicus on 11 Nov 2022 with no date or language restrictions. Randomised and non-randomised studies of pregnant women receiving ACS for preterm birth where maternal and newborn outcomes were reported for different administration-to-birth intervals were eligible. Eligibility screening, data extraction and risk of bias assessment were performed by two authors independently. Fetal and neonatal outcomes included perinatal and neonatal mortality, preterm birth-related morbidity outcomes and mean birthweight. Maternal outcomes included chorioamnionitis, maternal mortality, endometritis, and maternal intensive care unit admission. Findings: Ten trials (4592 women; 5018 neonates), 45 cohort studies (at least 22,992 women; 30,974 neonates) and two case–control studies (355 women; 360 neonates) met the eligibility criteria. Across studies, 37 different time interval combinations were identified. There was considerable heterogeneity in included administration-to-birth intervals and populations. The odds of neonatal mortality, respiratory distress syndrome and intraventricular haemorrhage were associated with the ACS administration-to-birth interval. However, the interval associated with the greatest improvements in newborn outcomes was not consistent across studies. No reliable data were available for maternal outcomes, though odds of chorioamnionitis might be associated with longer intervals. Intepretation: An optimal ACS administration-to-birth interval likely exists, however variations in study design limit identification of this interval from available evidence. Future research should consider advanced analysis techniques such as individual patient data meta-analysis to identify which ACS administration-to-birth intervals are most beneficial, and how these benefits can be optimised for women and newborns. Funding: This study was conducted with funding support from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), a co-sponsored programme executed by the World Health Organization.http://www.sciencedirect.com/science/article/pii/S2589537023000937BetamethasoneDexamethasoneGlucocorticoidsEvidence-synthesisNeonatal mortality |
| spellingShingle | Annie R.A. McDougall Lily Aboud Tina Lavin Jenny Cao Gabrielle Dore Jen Ramson Olufemi T. Oladapo Joshua P. Vogel Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in context EClinicalMedicine Betamethasone Dexamethasone Glucocorticoids Evidence-synthesis Neonatal mortality |
| title | Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in context |
| title_full | Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in context |
| title_fullStr | Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in context |
| title_full_unstemmed | Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in context |
| title_short | Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic reviewResearch in context |
| title_sort | effect of antenatal corticosteroid administration to birth interval on maternal and newborn outcomes a systematic reviewresearch in context |
| topic | Betamethasone Dexamethasone Glucocorticoids Evidence-synthesis Neonatal mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2589537023000937 |
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