Gestational age-specific risks vs benefits of multicourse antenatal corticosteroids for preterm labor

Laurie C. Zephyrin*, Kimberly N. Hong, Ronald J. Wapner, Alan M Peaceman, Yoram Sorokin, Donald J. Dudley, Jay D. Iams, Margaret Harper, Steve N. Caritis, Brian M. Mercer, John M. Thorp, Susan M. Ramin, Dwight J. Rouse, Baha Sibai

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective The purpose of this study was to estimate a gestational age threshold at which the benefits of treatment with weekly courses of antenatal corticosteroids (ACS) during preterm labor outweigh the risks. Study Design Risk-benefit ratios by gestational age were determined with the use of a Markov microsimulation decision-analysis model with a 1-week cycle length. Single course and multiple (weekly to a maximum of 4) courses of ACS by gestational age of entry (23 weeks to 31 weeks 6 days' gestation) were compared. Benefits were composite events (respiratory distress syndrome, chronic lung disease, severe intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, or stillbirth) averted. Risks were small head circumference and small for gestational age. Results More composite events are averted (benefits) than risks acquired (ratio, 6:1) when multiple courses of ACS are initiated at 26 weeks' gestation. When multiple courses of ACS are initiated at 29 weeks' gestation, the risk-benefit ratio is 1. Beyond 29 weeks, there is a suggestion of more risk than benefit. Conclusion The model suggests that multiple courses of ACS that are initiated at <29 weeks' gestation may have increased benefit compared with risks. Further analyses are needed to determine the long-term clinical significance of these findings.

Original languageEnglish (US)
Pages (from-to)330.e1-330.e7
JournalAmerican journal of obstetrics and gynecology
Volume209
Issue number4
DOIs
StatePublished - Jan 1 2013

Fingerprint

Premature Obstetric Labor
Gestational Age
Adrenal Cortex Hormones
Pregnancy
Odds Ratio
Periventricular Leukomalacia
Bronchopulmonary Dysplasia
Stillbirth
Decision Support Techniques
Lung Diseases
Chronic Disease
Head
Hemorrhage

Keywords

  • antenatal corticosteroid
  • decision analysis
  • preterm labor

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Zephyrin, Laurie C. ; Hong, Kimberly N. ; Wapner, Ronald J. ; Peaceman, Alan M ; Sorokin, Yoram ; Dudley, Donald J. ; Iams, Jay D. ; Harper, Margaret ; Caritis, Steve N. ; Mercer, Brian M. ; Thorp, John M. ; Ramin, Susan M. ; Rouse, Dwight J. ; Sibai, Baha. / Gestational age-specific risks vs benefits of multicourse antenatal corticosteroids for preterm labor. In: American journal of obstetrics and gynecology. 2013 ; Vol. 209, No. 4. pp. 330.e1-330.e7.
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abstract = "Objective The purpose of this study was to estimate a gestational age threshold at which the benefits of treatment with weekly courses of antenatal corticosteroids (ACS) during preterm labor outweigh the risks. Study Design Risk-benefit ratios by gestational age were determined with the use of a Markov microsimulation decision-analysis model with a 1-week cycle length. Single course and multiple (weekly to a maximum of 4) courses of ACS by gestational age of entry (23 weeks to 31 weeks 6 days' gestation) were compared. Benefits were composite events (respiratory distress syndrome, chronic lung disease, severe intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, or stillbirth) averted. Risks were small head circumference and small for gestational age. Results More composite events are averted (benefits) than risks acquired (ratio, 6:1) when multiple courses of ACS are initiated at 26 weeks' gestation. When multiple courses of ACS are initiated at 29 weeks' gestation, the risk-benefit ratio is 1. Beyond 29 weeks, there is a suggestion of more risk than benefit. Conclusion The model suggests that multiple courses of ACS that are initiated at <29 weeks' gestation may have increased benefit compared with risks. Further analyses are needed to determine the long-term clinical significance of these findings.",
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author = "Zephyrin, {Laurie C.} and Hong, {Kimberly N.} and Wapner, {Ronald J.} and Peaceman, {Alan M} and Yoram Sorokin and Dudley, {Donald J.} and Iams, {Jay D.} and Margaret Harper and Caritis, {Steve N.} and Mercer, {Brian M.} and Thorp, {John M.} and Ramin, {Susan M.} and Rouse, {Dwight J.} and Baha Sibai",
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Zephyrin, LC, Hong, KN, Wapner, RJ, Peaceman, AM, Sorokin, Y, Dudley, DJ, Iams, JD, Harper, M, Caritis, SN, Mercer, BM, Thorp, JM, Ramin, SM, Rouse, DJ & Sibai, B 2013, 'Gestational age-specific risks vs benefits of multicourse antenatal corticosteroids for preterm labor', American journal of obstetrics and gynecology, vol. 209, no. 4, pp. 330.e1-330.e7. https://doi.org/10.1016/j.ajog.2013.06.009

Gestational age-specific risks vs benefits of multicourse antenatal corticosteroids for preterm labor. / Zephyrin, Laurie C.; Hong, Kimberly N.; Wapner, Ronald J.; Peaceman, Alan M; Sorokin, Yoram; Dudley, Donald J.; Iams, Jay D.; Harper, Margaret; Caritis, Steve N.; Mercer, Brian M.; Thorp, John M.; Ramin, Susan M.; Rouse, Dwight J.; Sibai, Baha.

In: American journal of obstetrics and gynecology, Vol. 209, No. 4, 01.01.2013, p. 330.e1-330.e7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Gestational age-specific risks vs benefits of multicourse antenatal corticosteroids for preterm labor

AU - Zephyrin, Laurie C.

AU - Hong, Kimberly N.

AU - Wapner, Ronald J.

AU - Peaceman, Alan M

AU - Sorokin, Yoram

AU - Dudley, Donald J.

AU - Iams, Jay D.

AU - Harper, Margaret

AU - Caritis, Steve N.

AU - Mercer, Brian M.

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Rouse, Dwight J.

AU - Sibai, Baha

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Objective The purpose of this study was to estimate a gestational age threshold at which the benefits of treatment with weekly courses of antenatal corticosteroids (ACS) during preterm labor outweigh the risks. Study Design Risk-benefit ratios by gestational age were determined with the use of a Markov microsimulation decision-analysis model with a 1-week cycle length. Single course and multiple (weekly to a maximum of 4) courses of ACS by gestational age of entry (23 weeks to 31 weeks 6 days' gestation) were compared. Benefits were composite events (respiratory distress syndrome, chronic lung disease, severe intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, or stillbirth) averted. Risks were small head circumference and small for gestational age. Results More composite events are averted (benefits) than risks acquired (ratio, 6:1) when multiple courses of ACS are initiated at 26 weeks' gestation. When multiple courses of ACS are initiated at 29 weeks' gestation, the risk-benefit ratio is 1. Beyond 29 weeks, there is a suggestion of more risk than benefit. Conclusion The model suggests that multiple courses of ACS that are initiated at <29 weeks' gestation may have increased benefit compared with risks. Further analyses are needed to determine the long-term clinical significance of these findings.

AB - Objective The purpose of this study was to estimate a gestational age threshold at which the benefits of treatment with weekly courses of antenatal corticosteroids (ACS) during preterm labor outweigh the risks. Study Design Risk-benefit ratios by gestational age were determined with the use of a Markov microsimulation decision-analysis model with a 1-week cycle length. Single course and multiple (weekly to a maximum of 4) courses of ACS by gestational age of entry (23 weeks to 31 weeks 6 days' gestation) were compared. Benefits were composite events (respiratory distress syndrome, chronic lung disease, severe intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, or stillbirth) averted. Risks were small head circumference and small for gestational age. Results More composite events are averted (benefits) than risks acquired (ratio, 6:1) when multiple courses of ACS are initiated at 26 weeks' gestation. When multiple courses of ACS are initiated at 29 weeks' gestation, the risk-benefit ratio is 1. Beyond 29 weeks, there is a suggestion of more risk than benefit. Conclusion The model suggests that multiple courses of ACS that are initiated at <29 weeks' gestation may have increased benefit compared with risks. Further analyses are needed to determine the long-term clinical significance of these findings.

KW - antenatal corticosteroid

KW - decision analysis

KW - preterm labor

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