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Vogel JP, Oladapo OT, Pileggi-Castro C, et al. Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials. BMJ Glob Health. 2017;2(3):e000398doi: 10.1136/bmjgh-2017-000398.
Vogel, J. P., Oladapo, O. T., Pileggi-Castro, C., Adejuyigbe, E. A., Althabe, F., Ariff, S., Ayede, A. I., Baqui, A. H., Costello, A., Chikamata, D. M., Crowther, C., Fawole, B., Gibbons, L., Jobe, A. H., Kapasa, M. L., Kinuthia, J., Kriplani, A., Kuti, O., Neilson, J., Patterson, J., Piaggio, G., Qureshi, R., Qureshi, Z., Sankar, M. J., Stringer, J. S. A., Temmerman, M., Yunis, K., Bahl, R., & Metin Gülmezoglu, A. (2017). Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials. BMJ global health, 2(3), e000398. https://doi.org/10.1136/bmjgh-2017-000398
Vogel, Joshua P, et al. "Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials." BMJ global health vol. 2,3 (2017): e000398. doi: https://doi.org/10.1136/bmjgh-2017-000398
Vogel JP, Oladapo OT, Pileggi-Castro C, Adejuyigbe EA, Althabe F, Ariff S, Ayede AI, Baqui AH, Costello A, Chikamata DM, Crowther C, Fawole B, Gibbons L, Jobe AH, Kapasa ML, Kinuthia J, Kriplani A, Kuti O, Neilson J, Patterson J, Piaggio G, Qureshi R, Qureshi Z, Sankar MJ, Stringer JSA, Temmerman M, Yunis K, Bahl R, Metin Gülmezoglu A. Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials. BMJ Glob Health. 2017 Aug 30;2(3):e000398. doi: 10.1136/bmjgh-2017-000398. eCollection 2017. PMID: 29082019; PMCID: PMC5656119.
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BMJ Glob Health. 2017 Aug 30;2(3):e000398. doi: 10.1136/bmjgh-2017-000398. eCollection 2017.

Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials.

BMJ global health

Joshua P Vogel, Olufemi T Oladapo, Cynthia Pileggi-Castro, Ebunoluwa A Adejuyigbe, Fernando Althabe, Shabina Ariff, Adejumoke Idowu Ayede, Abdullah H Baqui, Anthony Costello, Davy M Chikamata, Caroline Crowther, Bukola Fawole, Luz Gibbons, Alan H Jobe, Monica Lulu Kapasa, John Kinuthia, Alka Kriplani, Oluwafemi Kuti, James Neilson, Janna Patterson, Gilda Piaggio, Rahat Qureshi, Zahida Qureshi, Mari Jeeva Sankar, Jeffrey S A Stringer, Marleen Temmerman, Khalid Yunis, Rajiv Bahl, A Metin Gülmezoglu

Affiliations

  1. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
  2. Department of Maternal Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
  3. Department of Paediatrics and Child Health, Obafemi Awolowo University, Ife, Nigeria.
  4. Department of Mother and Child Health Research for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
  5. Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan.
  6. Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
  7. International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  8. Ministry of Community Development, Mother & Child Health, Lusaka, Zambia.
  9. Liggins Institute, The University of Auckland, Auckland, New Zealand.
  10. Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
  11. Department of Pediatrics, Cincinnati Childrens Hospital, Cincinnati, Ohio, USA.
  12. Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia.
  13. Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya.
  14. All India Institute of Medical Sciences, New Delhi, India.
  15. Department of Obstetrics, Gynaecology and Perinatology, College of Health Sciences, Obafemi Awolowo University, Ife, Nigeria.
  16. Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK.
  17. Maternal, Newborn, and Child Health, Bill and Melinda Gates Foundation, Geneva, Switzerland.
  18. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
  19. Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan.
  20. Department of Obstetrics and Gynaecology, School of Medicine, University of Nairobi, Nairobi, Kenya.
  21. Department of Pediatrics, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
  22. University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA.
  23. National Collaborative Perinatal Neonatal Network, American University of Beirut, Beirut, Lebanon.

PMID: 29082019 PMCID: PMC5656119 DOI: 10.1136/bmjgh-2017-000398

Abstract

The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials-the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial-have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns. In this article, we briefly present an appraisal of the current evidence around ACS, how these findings informed WHO's current recommendations on ACS use, and the knowledge gaps that have emerged in the light of new trial evidence. Critical considerations in the generalisability of the available evidence demonstrate that a true state of clinical equipoise exists for this treatment option in low-resource settings. An expert group convened by WHO concluded that there is a clear need for more efficacy trials of ACS in these settings to inform clinical practice.

Keywords: antenatal corticosteroids; neonatal mortality; preterm birth

Conflict of interest statement

Competing interests: CC is currently chief investigator on a randomised controlled trial to evaluate the role of maternal intramuscular dexamethasone versus betamethasone prior to preterm birth (A*STE

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