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Furthermore, clinical trials cited in the most recent Cochrane Review have limitations which should be taken into account when considering the use of antenatal corticosteroids in clinical practice.1 ,3 ,25 ,26 ,27 ,44 ,45 ,46 The Cochrane review noted that in addition to the limitations of the clinical trials, the limitations of the methodology employed to analyze studies include "the quality of data extracted, the use of a number of outcome measures that may have been confounded, and the use of non-standard statistical methods." A clinical trial needs to be considered in addition to the design and characteristics of the cohort. The Cochrane review noted a significant improvement in maternal outcomes during the second trimester from antenatal corticosteroids compared to placebo. However, there remained some limitations in the methodological quality of the trials, including not meeting the highest quality standard for analysis.3 ,27 ,44 ,45 ,46 ,47 The Cochrane review also noted that, "a number of study shortcomings such as inadequate allocation concealment and loss to follow-up or withdrawal of participants from the trials and the lack of appropriate statistical analysis precluded any definitive conclusion as to the relative efficacy of antenatal corticosteroids."3 Overall, the Cochrane review concluded that "a systematic review of five randomised trials involving 1,019 women revealed a statistically significant increased risk of major malformations in the second or third trimester when compared with placebo, which was not confirmed in two smaller trials."3 The authors of the Cochrane review also noted that "the findings are inconsistent and the conclusions are inconclusive," especially because no study showed that maternal corticosteroids resulted in a direct reduction of complications.28 The report also noted that in light of this, "there does not seem to be any substantial basis for a recommendation for the routine use of antenatal corticosteroids in selected areas of the world. The evidence that is available has shown that these agents have a small effect on the incidence or severity of malformations."28 What Is the Conclusions? This Cochrane review and the other observational trial studies provide more evidence that prenatal corticosteroids can reduce the risk of major malformations, but they also demonstrate that there is likely some limitation to their benefit in this population. The risk of adverse events is higher in the second trimester of pregnancy. The benefit in reducing the occurrence of malformations appears small. In the majority of cases, the benefit appears to be limited to malformations that occur later in pregnancy. There is some evidence that there is no benefit in reducing malformations associated with chromosomal abnormalities or other serious congenital anomalies.29 A Similar articles:

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