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Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practiceor in research. The first study included in the Cochrane review was a systematic review of six Cochrane trials published between 2002 and 2012.14 The review included nine studies of antenatal corticosteroids in 37 000 women. Four trials found the use of corticosteroids to be effective in inducing labour (11, 20–23, 46, 47). A meta-analysis of six trials comparing antenatal corticosteroids and standard anaesthetics showed that the use of antenatal corticosteroids was associated with a significantly lower probability of intrapartum maternal mortality; a reduced risk of caesarean section; and a significantly lower risk of low birthweight.14,15 The second Cochrane review was a systematic review of eight Cochrane trials involving a total of 5500 babies who had received antenatal corticosteroids.16 The study was not a randomized controlled trial and therefore could not be regarded as an appropriate basis for drawing conclusions about the impact of antenatal corticosteroid exposure on their long-term effects. There were only four studies that specifically compared the use of antenatal corticosteroids with the use of standard anaesthetic. All four showed the use of antenatal corticosteroids to be less effective and there were fewer adverse effects observed in babies treated with antenatal corticosteroids (8% fewer episodes of hypotonic, 15% fewer episodes of sepsis, 16% fewer episiotomies and 9% fewer intrauterine growth restriction). This study could not be considered a sufficient basis for drawing conclusions about the impact of antenatal corticosteroid exposure on the length of their pregnancy or on their pregnancy outcomes.17 Both studies of the Cochrane review that considered the impact of antenatal corticosteroid exposure on pregnant women found that the use of antenatal corticosteroids was associated with a higher occurrence of preterm birth, which means that the use of antenatal corticosteroid is associated with the increased risk of preterm birth that is linked to pregnancy exposure. It is important to note that many women who benefit from antenatal corticosteroid use and who are not as susceptible to preterm birth are also not as susceptible to other causes of preterm birth. Therefore, antenatal corticosteroid use is associated with an increased risk of preterm birth in the population and therefore the use of antenatal corticosteroid could be associated with a reduction in the overall incidence of preterm birth. However, there is no evidence from any of Similar articles:

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