Skoll Amanda, Boutin Amélie, Bujold Emmanuel, Burrows Jason, Crane Joan, Geary Michael, Jain Venu, Lacaze-Masmonteil Thierry, Liauw Jessica, Mundle William, Murphy Kellie, Wong Suzanne, Joseph K S
Vancouver, BC.
Québec City, QC.
J Obstet Gynaecol Can. 2018 Sep;40(9):1219-1239. doi: 10.1016/j.jogc.2018.04.018.
To assess the benefits and risks of antenatal corticosteroid therapy for women at risk of preterm birth or undergoing pre-labour Caesarean section at term and to make recommendations for improving neonatal and long-term outcomes.
To administer or withhold antenatal corticosteroid therapy for women at high risk of preterm birth or women undergoing pre-labour Caesarean section at term.
Perinatal morbidity, including respiratory distress syndrome, intraventricular hemorrhage, bronchopulmonary dysplasia, infection, hypoglycemia, somatic and brain growth, and neurodevelopment; perinatal mortality; and maternal morbidity, including infection and adrenal suppression.
Maternity care providers including midwives, family physicians, and obstetricians.
Pregnant women.
Medline, PubMed, Embase, and the Cochrane Library were searched from inception to September 2017. Medical Subject Heading (MeSH) terms and key words related to pregnancy, prematurity, corticosteroids, and perinatal and neonatal mortality and morbidity were used. Statements from professional organizations including that of the National Institutes of Health, the American College of Obstetricians and Gynecologists, the Society for Maternal Fetal Medicine, the Royal College of Obstetricians and Gynaecologists, and the Canadian Pediatric Society were reviewed for additional references. Randomized controlled trials conducted in pregnant women evaluating antenatal corticosteroid therapy and previous systematic reviews on the topic were eligible. Evidence from systematic reviews of non-experimental (cohort) studies was also eligible.
This Committee Opinion has been reviewed and approved by the Maternal-Fetal Medicine Committee of the SOGC and approved by SOGC Council.
BENEFITS, HARMS, AND/OR COSTS: A course of antenatal corticosteroid therapy administered within 7 days of delivery significantly reduces perinatal morbidity/mortality associated with preterm birth between 24 + 0 and 34 + 6 weeks gestation. When antenatal corticosteroid therapy is given more than 7 days prior to delivery or after 34 + 6 weeks gestation, the adverse effects may outweigh the benefits. Evidence on long-term effects is scarce, and potential neurodevelopment harms are unquantified in cases of late preterm, term, and repeated exposure to antenatal corticosteroid therapy.
Evidence will be reviewed 5 years after publication to evaluate the need for a complete or partial update of the guideline. If important evidence is published prior to the 5-year time point, an update will be issued to reflect new knowledge and recommendations.
The guideline was developed with resources provided by the Society of Obstetricians and Gynaecologists of Canada with support from the Canadian Institutes of Health Research (APR-126338).
RECOMMENDATIONS: Gestational Age Considerations Agents, Dosage, Regimen, and Target Timing Subpopulations and Special Consideration.
评估产前使用糖皮质激素治疗对有早产风险或足月行剖宫产的妇女的益处和风险，并提出改善新生儿及长期预后的建议。
对有早产高风险的妇女或足月行剖宫产的妇女给予或不给予产前糖皮质激素治疗。
围产期发病率，包括呼吸窘迫综合征、脑室内出血、支气管肺发育不良、感染、低血糖、躯体和脑部生长以及神经发育；围产期死亡率；以及孕产妇发病率，包括感染和肾上腺抑制。
包括助产士、家庭医生和产科医生在内的孕产妇护理提供者。
孕妇。
检索了Medline、PubMed、Embase和Cochrane图书馆自建库至2017年9月的文献。使用了与妊娠、早产、糖皮质激素以及围产期和新生儿死亡率及发病率相关的医学主题词（MeSH）和关键词。还查阅了包括美国国立卫生研究院、美国妇产科医师学会、母胎医学协会、皇家妇产科医师学院和加拿大儿科学会等专业组织的声明以获取更多参考文献。纳入评估产前糖皮质激素治疗的孕妇随机对照试验以及之前关于该主题的系统评价。非实验性（队列）研究的系统评价证据也符合要求。
本委员会意见已由加拿大妇产科医师学会母胎医学委员会审核并批准，且经加拿大妇产科医师学会理事会批准。
益处、危害和/或成本：在分娩前7天内给予一个疗程的产前糖皮质激素治疗可显著降低孕24⁺⁰至34⁺⁶周早产相关的围产期发病率/死亡率。若在分娩前7天以上或孕34⁺⁶周后给予产前糖皮质激素治疗，不良反应可能超过益处。关于长期影响的证据稀缺，在晚期早产、足月及反复接受产前糖皮质激素治疗的情况下，潜在的神经发育危害尚未量化。
指南发布后五年将对证据进行审查，以评估是否需要对指南进行全面或部分更新。如果在5年时间点之前发表了重要证据，将发布更新以反映新知识和建议。
本指南由加拿大妇产科医师学会提供资源，并在加拿大卫生研究院（项目编号：APR - 126338）的支持下制定。
建议：孕周考虑因素、药物、剂量、方案和目标时机、亚人群及特殊考虑因素。
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