A standard prenatal treatment in the United States and other high-income countries for pregnant women at high risk for preterm birth may potentially cause harm if implemented in low-income countries, according to new findings published in the journal The Lancet. The study was conducted by researchers from the Global Network for Women’s and Children’s Health Research at the National Institute of Health’s (NIH) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), with additional support from the World Health Organization (WHO).
Presently, 80% of pregnant women at high risk for preterm delivery in high-income countries receive corticosteroids vs. only 10% in low-income countries. The 18-month study enrolled over 100,000 pregnant women in Argentina, Guatemala, India, Pakistan, Kenya, and Zambia to assess the efficacy of prenatal corticosteroids for women at high risk of preterm delivery in reducing newborn deaths associated with preterm delivery. Women were randomly assigned to receive corticosteroids if they had signs and symptoms that indicated a high risk of delivery prior to Week 36 of the pregnancy or standard care (control group). A preterm infant was defined as having a birth weight lower than the fifth percentile among all infants born in a study location.
In the intervention group, 5.2% of infants born were below the fifth percentile and 45.2% of the women delivering these infants were given corticosteroids. In the control group, 4.3% of infants were born below the fifth percentile but only 10.4% of the women delivering these infants received corticosteroids. The women in the standard care group did not receive the corticosteroids as part of the study but may have received them as part of treatment from local healthcare workers as part of local standards of care.
Newborn deaths by the 28th day of life did not differ significantly among the intervention and control groups for all infants below the fifth percentile. More deaths at 28 days did occur among the intervention group compared to the control group and perinatal mortality was higher for infants in the intervention group. Rates of post-birth infections were greater in the intervention group (2.5%) compared to the control group (2.5 vs. 1.7%, respectively).
While previous research has shown that use of corticosteroid therapy can be beneficial in advance care hospital settings, the use in low resources areas should be limited to women who are able to give birth in hospital settings to ensure proper assessment of gestational age and proper training for corticosteroid therapy administration, state the authors.
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