RT Journal Article
SR Electronic
T1 Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e000398
DO 10.1136/bmjgh-2017-000398
VO 2
IS 3
A1 Vogel, Joshua P
A1 Oladapo, Olufemi T
A1 Pileggi-Castro, Cynthia
A1 Adejuyigbe, Ebunoluwa A
A1 Althabe, Fernando
A1 Ariff, Shabina
A1 Ayede, Adejumoke Idowu
A1 Baqui, Abdullah H
A1 Costello, Anthony
A1 Chikamata, Davy M
A1 Crowther, Caroline
A1 Fawole, Bukola
A1 Gibbons, Luz
A1 Jobe, Alan H
A1 Kapasa, Monica Lulu
A1 Kinuthia, John
A1 Kriplani, Alka
A1 Kuti, Oluwafemi
A1 Neilson, James
A1 Patterson, Janna
A1 Piaggio, Gilda
A1 Qureshi, Rahat
A1 Qureshi, Zahida
A1 Sankar, Mari Jeeva
A1 Stringer, Jeffrey S A
A1 Temmerman, Marleen
A1 Yunis, Khalid
A1 Bahl, Rajiv
A1 Metin Gülmezoglu, A
YR 2017
UL http://gh.bmj.com/content/2/3/e000398.abstract
AB 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.