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World J Exp Med. Sep 20, 2021; 11(4): 37-43
Published online Sep 20, 2021. doi: 10.5493/wjem.v11.i4.37
Antenatal corticosteroids in COVID-19 perspective
Alex C Vidaeff, Kjersti M Aagaard, Michael A Belfort
Alex C Vidaeff, Kjersti M Aagaard, Michael A Belfort, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Texas Children’s Hospital, Baylor College Medicine, Houston, TX 77030, United States
Author contributions: Vidaeff AC, Aagaard KM and Belfort MA contributed equally to this work and wrote the manuscript; all authors have read and approve the final manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alex C Vidaeff, MD, Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Texas Childrens Hospital, Baylor College Medicine, 6651 Main St, Suite F1020, Houston, TX 77030, United States. vidaeff@bcm.edu
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: May 14, 2021
Revised: May 23, 2021
Accepted: September 2, 2021
Article in press: September 2, 2021
Published online: September 20, 2021
Processing time: 169 Days and 10.7 Hours
Abstract

The aim of this manuscript is to discuss the practice of antenatal corticosteroids administration for fetal maturation in severe acute respiratory syndrome coronavirus 2 positive pregnant women. Recent high-quality evidence supports the use of dexamethasone in the treatment of hospitalized patients with coronavirus disease 2019 (COVID-19). Randomized disease outcome data have identified an association between disease stage and treatment outcome. In contrast to patients with more severe forms who benefit from dexamethasone, patients with mild disease do not appear to improve and may even be harmed by this treatment. Therefore, indiscriminate usage of fluorinated corticosteroids for fetal maturation, regardless of disease trajectory, is unadvisable. Obstetrical care needs to be adjusted during the COVID-19 pandemic with careful attention paid to candidate selection and risk stratification.

Keywords: Antenatal corticosteroids; COVID-19; Dexamethasone; Pregnancy; SARS-CoV-2; Preterm delivery

Core Tip: Evidence from the randomized evaluation of coronavirus disease 2019 therapy trial supports the use of dexamethasone in the setting of maternal respiratory disease requiring either invasive mechanical ventilation or oxygen alone but not for patients receiving no respiratory support. Dexamethasone will have the added benefit of promoting fetal maturity at < 34 wk gestation in cases at risk for preterm delivery. Fetal indications for antenatal corticosteroids should be limited to obstetrical indications resulting in a high probability of preterm delivery and indiscriminate usage of fluorinated corticosteroids for fetal maturation, regardless of disease stage, is unadvisable.