Use of corticosteroids to accelerate fetal lung maturity in severe pre-eclampsia

BACKGROUND: the efficacy of antenatal corticosteroid therapy in reducing the incidence of hyaline membrane disease (HMD) in severe cases of pre-eclampsia, as well as the possible maternal and fetal side effects, have not yet been established in well-controlled studies. OBJECTIVES: to determine the efficacy for the prevention of HMD and the maternal and perinatal outcomes of antenatal corticosteroid therapy in pregnant women with severe pre-eclampsia. SUBJECTS AND METHODS: a prospective, randomized, double-blind clinical trial was carried out involving 218 pregnant women with severe pre-eclampsia and gestational age between 26-34 weeks, of whom 110 received betamethasone (12 mg IM, weekly) and 108 placebo. Only cases of singleton pregnancy, with well-documented gestational age and a live fetus at admission, with an interval between treatment and delivery >24 hours were included in the study; cases of premature rupture of membranes, associated maternal diseases and congenital malformations were excluded. The statistical analysis used the test of differences of means (Mann-Whitney) and the chi-square test of association, and the relative risk (with 95 percent confidence interval) of HMD was calculated according to the use or non-use of corticosteroid, stratified by gestational age. The relative risk of other neonatal complications (necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, neonatal infection and perinatal mortality) and maternal complications (acute pulmonary edema, worsening of hypertension, HELLP syndrome, maternal infection, acute renal failure and death) for the use of corticosteroid was also determined. RESULTS: the frequency of HMD was significantly lower in the group that received corticosteroid (23 percent) than in the placebo group (43 percent), with a relative risk of 0.53 (0.35-0.82) and a risk adjusted for gestational age of 0.56. A significant reduction was found in the risk of intraventricular hemorrhage, 0.35 (0.15-0.86), patent ductus arteriosus, 0.27 (0.08-0.95) and perinatal infection, 0.59 (0.36-0.97).