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Steroids for Women in Premature Labor and Infant Outcomes

Treatment with betamethasone, but not dexamethasone, was associated with unimpaired neurodevelopmental status, compared with no steroid treatment.

For more than a decade, steroids have been a mainstay of obstetric practice for women who are in premature labor and are expected to deliver a premature infant. Although two steroids — dexamethasone and betamethasone — are used for this purpose, some studies suggest that prenatal dexamethasone is associated with increased risk for adverse neurocognitive outcomes in infants. Investigators evaluated outcomes in 1124 infants (birth weight, 401–1000 g) at a corrected gestational age of 18 to 22 months who participated in an NIH-sponsored follow-up study: 153 were not exposed to steroids, 408 were exposed to dexamethasone, and 563 were exposed to betamethasone.

Overall, 12% of the infants had cerebral palsy, 21% had poor motor development, 32% had poor cognitive development, 2% were hearing impaired, and 1% were blind. Compared with no steroid treatment, use of prenatal betamethasone was significantly associated with unimpaired neurodevelopmental status (normal motor and cognitive development; no cerebral palsy, blindness, or deafness; odds ratio, 2.42), but use of dexamethasone was not (OR, 1.50). Compared with betamethasone, dexamethasone was associated with a trend toward an increased risk for poor psychomotor development.

Comment: These data suggest that betamethasone is associated with better outcomes than is dexamethasone in infants of women in premature labor. The results are consistent with both animal models and other clinical studies but inconsistent with a recent randomized, controlled trial (Obstet Gynecol 2007; 110:26) in which dexamethasone was more effective than betamethasone at reducing the rate of intraventricular hemorrhage. The authors acknowledge that these observational results should be interpreted with caution.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine February 27, 2008

Citation(s):

Lee BH et al. Neurodevelopmental outcomes of extremely low birth weight infants exposed prenatally to dexamethasone versus betamethasone. Pediatrics 2008 Feb; 121:289.

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