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

Authors

Joshua P. Vogel, World Health Organization, Geneva
Olufemi T. Oladapo, World Health Organization, Geneva
Cynthia Pileggi-Castro, World Health Organization, Geneva
Ebunoluwa A. Adejuyigbe, Obafemi Awolowo University
Fernando Althabe, Department of Mother and Child Health Research for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
Shabina Ariff, Aga Khan University
Adejumoke Idowu Ayede, University of Ibadan
Abdullah H. Baqui, Johns Hopkins Bloomberg School of Public Health
Anthony Costello, World Health Organization, Geneva
Davy M. Chikamata, Ministry of Community Development, Mother & Child Health, Lusaka
Caroline Crowther, The University of Auckland
Bukola Fawole, University of Ibadan
Luz Gibbons, Department of Mother and Child Health Research for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
Alan H. Jobe, Cincinnati Childrens Hospital
Monica Lulu Kapasa, University Teaching Hospital, Lusaka
John Kinuthia, Kenyatta National Hospital
Alka Kriplani, All India Institute of Medical Sciences
Oluwafemi Kuti, Obafemi Awolowo University
James Neilson, The University of Liverpool
Janna Patterson, Bill and Melinda Gates Foundation
Gilda Piaggio, London School of Hygiene and Tropical Medicine
Rahat Qureshi, Aga Khan UniversityFollow
Zahida Qureshi, University of Nairobi
Mari Jeeva Sankar, All India Institute of Medical Sciences (AIIMS)
Jeffrey S. A. Stringer, University of North Carolina
Marleen Temmerman, Aga Khan UniversityFollow
Khalid Yunis, American University of Beirut
Rajiv Bahl, World Health Organization, Geneva
A. Metin Gülmezoglu, World Health Organization, Geneva

Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

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.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

BMJ Global Health

Recommended Citation

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., Temmerman, M., Yunis, K., Bahl, R., Gülmezoglu, A. M. (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), 1-7.
Available at: https://ecommons.aku.edu/eastafrica_fhs_mc_obstet_gynaecol/166