Vogel Joshua P, Oladapo Olufemi T, Pileggi-Castro Cynthia, Adejuyigbe Ebunoluwa A, Althabe Fernando, Ariff Shabina, Ayede Adejumoke Idowu, Baqui Abdullah H, Costello Anthony, Chikamata Davy M, Crowther Caroline, Fawole Bukola, Gibbons Luz, Jobe Alan H, Kapasa Monica Lulu, Kinuthia John, Kriplani Alka, Kuti Oluwafemi, Neilson James, Patterson Janna, Piaggio Gilda, Qureshi Rahat, Qureshi Zahida, Sankar Mari Jeeva, Stringer Jeffrey S A, Temmerman Marleen, Yunis Khalid, Bahl Rajiv, Metin Gülmezoglu A
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.
Department of Maternal Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
BMJ Glob Health. 2017 Aug 30;2(3):e000398. doi: 10.1136/bmjgh-2017-000398. eCollection 2017.
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.
近年来，针对有早产风险的女性使用产前糖皮质激素（ACS）的科学依据迅速发生了变化。两项具有里程碑意义的试验——产前糖皮质激素试验和产前晚期早产类固醇试验——对长期以来关于在包括资源有限环境在内的所有护理水平和情况下使用ACS预防早产的相对健康益处和危害的假设提出了挑战。在低收入和中等收入国家工作的研究人员、临床医生、项目管理人员、政策制定者和捐助者现在面临着具有挑战性的问题，即是否、在何处以及如何使用ACS来优化对女性和早产新生儿的治疗效果。在本文中，我们简要介绍了对当前围绕ACS的证据的评估，这些研究结果如何为世界卫生组织（WHO）目前关于ACS使用的建议提供依据，以及鉴于新的试验证据而出现的知识空白。对现有证据可推广性的关键考量表明，在低资源环境中，对于这种治疗选择存在真正的临床 equipoise 状态。WHO召集的一个专家小组得出结论，显然需要在这些环境中开展更多关于ACS的疗效试验，以为临床实践提供依据。
