Current Concepts and Controversies in the Use of Antenatal Corticosteroid Therapy for Prevention of Neonatal Morbidities

Since Liggins first reported the beneficial pulmonary effects in fetus after maternally administered corticosteroids in 1972, many subsequent studies have demonstrated that antenatal corticosteroids (ACS) administered to mothers can reduce the morbidity and mortality in their preterm neonates. However, serious concerns have been raised that this therapy is being overused and the use of repeated courses of antenatal corticosteroids may be associated with adverse effects on somatic and brain growth in a growing fetus. These concerns have led to the revised guidelines for antenatal corticosteroids use from National Institute of Health. This article will review the normal anatomy, physiology and regulation of function of adrenal gland in the fetus; rationale and evidence for use of antenatal corticosteroids for enhancement of fetal lung maturation; unresolved issues regarding antenatal corticosteroids therapy; and current guidelines for its use.