1. Corticosteroids should be administered to women at a gestational age between 24(+0)
and 33(+6) weeks, when preterm birth is anticipated in the next seven days, as these
have been consistently shown to reduce neonatal mortality and morbidity. (Strong-quality
evidence; strong recommendation). In selected cases, extension of this period up to
34(+6) weeks may be considered (Expert opinion). Optimal benefits are found in infants
delivered within 7 days of corticosteroid administration. Even a single-dose administration
should be given to women with imminent preterm birth, as this is likely to improve
neurodevelopmental outcome (Moderate-quality evidence; conditional recommendation).
2. Either betamethasone (12 mg administered intramuscularly twice, 24-hours apart)
or dexamethasone (6 mg administered intramuscularly in four doses, 12-hours apart,
or 12 mg administered intramuscularly twice, 24-hours apart), may be used (Moderate-quality
evidence; Strong recommendation). Administration of two "all" doses is named a "course
of corticosteroids". 3.Administration between 22(+0) and 23(+6) weeks should be considered
when preterm birth is anticipated in the next seven days and active newborn life-support
is indicated, taking into account parental wishes. Clear survival benefit has been
observed in these cases, but the impact on short-term neurological and respiratory
function, as well as long-term neurodevelopmental outcome is still unclear (Low/moderate-quality
evidence; Weak recommendation). 4.Administration between 34 + 0 and 34 + 6 weeks should
only be offered to a few selected cases (Expert opinion). Administration between 35(+0)
and 36(+6) weeks should be restricted to prospective randomized trials. Current evidence
suggests that although corticosteroids reduce the incidence of transient tachypnea
of the newborn, they do not affect the incidence of respiratory distress syndrome,
and they increase neonatal hypoglycemia. Long-term safety data are lacking (Moderate
quality evidence; Conditional recommendation). 5.Administration in pregnancies beyond
37(+0) weeks is not indicated, even for scheduled cesarean delivery, as current evidence
does not suggest benefit and the long-term effects remain unknown (Low-quality evidence;
Conditional recommendation). 6.Administration should be given in twin pregnancies,
with the same indication and doses as for singletons. However, existing evidence suggests
that it should be reserved for pregnancies at high-risk of delivering within a 7-day
interval (Low-quality evidence; Conditional recommendation). Maternal diabetes mellitus
is not a contraindication to the use of antenatal corticosteroids (Moderate quality
evidence; Strong recommendation). 7. A single repeat course of corticosteroids can
be considered in pregnancies at less than 34(+0) weeks gestation, if the previous
course was completed more than seven days earlier, and there is a renewed risk of
imminent delivery (Low-quality evidence; Conditional recommendation).
