Research overview
Antenatal steroids are one of the most widely prescribed medications in pregnancy, being administered to women at risk of preterm delivery. In the setting of preterm delivery at or below 35 weeks’ gestation, antenatal steroids reduce perinatal morbidity and mortality, primarily by promoting fetal lung maturation.
However, with expanding use of this intervention has come growing appreciation for the potential off target, adverse effects of antenatal steroid therapy on wider fetal development.
We undertook a narrative literature review of the animal and clinical literature to assess current evidence of adverse effects of antenatal steroid exposure and fetal development.
This review presents an increasing body of evidence concerning the wide ranging, off target, adverse effects of antenatal steroid therapy on fetal development and programming. We highlight an urgent need for further animal and clinical studies investigating the effects of antenatal steroids on the fetal and maternal immune, cardiovascular, renal and hepatic systems given a current sparsity of evidence.
We also strongly suggest an emphasis on open disclosure, discussion and education of clinicians and patients with regards to the potential benefits and risks of antenatal steroid therapy, particularly in late preterm and term gestations where infants derive very little benefit from these drugs.
We also suggest further studies on the optimization of antenatal steroid therapy through improved patient selection and improved dosing regimens based on a pharmacokinetic-pharmacodynamic informed understanding of antenatal steroid action on the fetal lung.
Project researchers
Dr Sean Carter
Professor Matt Kemp
Partners
Department of Obstetrics and Gynaecology, National University of Singapore, Singapore.
Division of Obstetrics and Gynaecology, University of Western Australia, Australia.
Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan.
Project timeline
Completed 2025
Publication
A review of the potential off-target effects of antenatal steroid exposures on fetal development
