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Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice. Although these studies reported the rate of adverse events in general population, this rate may be higher in children as it is likely that most adverse events to a pregnant patient are minor. Although we are aware of only one case of a child suffering adverse events to antenatal corticosteroids, in that case there was significant evidence which recommended more frequent maternal and infant use.26,27 The role of antenatal corticosteroids could vary depending on the patient. For example, in a study comparing the use of corticosteroids and progesterone on a subselective basis in women experiencing the antenatal influenza pandemic of 2007, the use of antenatal corticosteroids in conjunction with the use of progesterone had a significantly higher rate of adverse events.28 However, even then the use of both corticosteroids and progesterone might be associated with an increased risk of low birth weight of up to 9% for women and 12% for women with older pregnancies.29 While we did not have data to clarify which of these possible risks are the most severe, the findings on the use of antenatal corticosteroids by the population in general supports the need for ongoing surveillance of antenatal corticosteroids. There was one prospective observational study which did not have enough controls to draw a conclusion on progesterone and antenatal corticosteroids.30,31 There is, therefore, a need for studies of both progesterone and antenatal corticosteroids in a larger population to confirm that use of both would carry the same risk. However, such studies could not be performed in the absence of data for other potential causes of neonatal respiratory distress syndrome including pregnancy complications. If there are any causal factors linking both antenatal corticosteroids and progesterone, then we can expect these to result in similar outcomes between women using their own progestin or progestin only and women using an alternative hormone such as prostaglandin. A limitation of the study and of the current meta-analysis is the relatively small number of studies used. Despite this limitation, these studies highlight a need to perform surveillance of antenatal corticosteroids in the general population to inform an informed public-policy decision on whether to continue or modify use of both antenatal corticosteroids and progesterone. A number of potential confounding factors were identified, with the inclusion of several different population subgroups. However, these factors were not identified for the primary end point of adverse per Similar articles:


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