Long-term effects of antenatal administration of corticosteroids. Where are we?

There is increasing concern about the long-term effects of an-tenatal administration of corticosteroids, as some complications have been reported in neonates, adolescents and adults, which could be transmitted to subsequent generations, as it has been shown in animal and observational stud-ies in humans. In this review, we summarize the current understanding of the long-term effects of antenatal corticosteroid administration and provide data to inform the preparation of guidelines. A literature search was performed in the PubMed database. A mechanism has been proposed as to how antenatal administration of corticosteroids could produce morbidity in neonatal neuro-development and lead to future diseases in adulthood. However, this hypothesis has not been proven in large randomized controlled trials. We summarize here the current data supporting and opposing the long-term effects of antenatal corticosteroid administration. Follow-up studies from randomized controlled trials have found no increased risk of neurologic impairment in children af-ter exposure to a single course of antenatal corticosteroids. Observational and clinical trials of maternally administered antenatal corticosteroids show no evi-dence of increased disability on follow-up and describe associations rather than a proximate cause. Before 34 weeks of gestation, antenatal administration of corticosteroids in women at high risk for preterm birth appears to improve most neurodevelopmental outcomes. It is still recommended to administer a single course of corticosteroid treatment before preterm delivery.