So far, everything is ok bloodwork wise, but the OB consult yesterday suggested that we do it (I'll be 32 weeks on Thursday) just in case things go south in a hurry and we need to deliver.
I decided to wait until Thursday to see because I don't really understand the risks (he said there were none, so right there I knew I had to do more research), but also I understand that the effects take 24-48 hours to kick in and only last about 7 days, so I'm thinking we'd want to have a better idea of things going downhill before "locking in" so to speak.
Any thoughts or suggestions?
the only side effect i had was it increased my blood sugar. im a diabetic but maintain normal blood sugar without medication by restricting my diet. but i had to have insulin for about a week because of the shots. i was in the hospital so they monitored it very closely.
Side effects - I've never heard of any to the mother. Maybe the normal steroidal reactions? With the baby, I do know that since it is a steroid, there can be a few complications such as hypoglycemia, but as far as I know, none that are worse than a baby who isn't breathing well and has to be vented. I think betametazone also can protect against hemorrhage in preterm infants but I may be completely wrong on that. Your OB actually isn't that far off - in his mind, there probably aren't any side effects - most OBs very much believe that the benefits of these shots far outweigh the risks.
Personally, as someone who has had pre-eclampsia and had to deliver very early and very quickly, I would go for the shots as soon as possible. We didn't have time to get both in for me and I really regret that. I think they would have helped.
And FWIW it's not a very painful shot, at least.
mom to three, 4 and under.
I decided to wait until Thursday to see because I don't really understand the risks (he said there were none, so right there I knew I had to do more research)....Any thoughts or suggestions?
From National Guideline Clearinghouse
Effectiveness of Antenatal Corticosteroid Therapy
[Definitions:Grading of Recommendations:
Grade A - Requires at least one randomised controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation (evidence levels Ia, Ib)]
A - Clinicians should offer antenatal corticosteroid treatment to women at risk of preterm delivery because antenatal corticosteroids are associated with a significant reduction in rates of respiratory distress syndrome (RDS), neonatal death, and intraventricular haemorrhage.
A - Women may be advised that the use of a single course of antenatal corticosteroids does not appear to be associated with any significant maternal or fetal adverse effects.
Indications for Antenatal Corticosteroid Therapy
A - Every effort should be made to initiate antenatal corticosteroid therapy in women between 24 and 34 weeks of gestation with any of the following:
* Threatened preterm labour
* Antepartum haemorrhage
* Preterm rupture of membranes
* Any condition requiring elective preterm delivery
Between 35 to 36 weeks obstetricians might want to consider antenatal steroid use in any of the above conditions although the numbers needed to treat will increase significantly. [Evidence level Ia]
Antenatal education programmes or patient information leaflets should be considered to encourage early recognition of these conditions, in an effort to ensure early presentation and commencement of treatment. Maternity services should consider multidisciplinary staff training in providing information, including risk ratios, to women.
From the National Institutes of Health, Consensus Development Conference Statement (February 28-March 2, 1994): The Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes
The consensus panel concluded that antenatal corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome, and intraventricular hemorrhage in preterm infants. These benefits extend to a broad range of gestational ages (24 to 34 weeks) and are not limited by gender or race. Although the beneficial effects of corticosteroids are greatest more than 24 hours after beginning treatment, treatment less than 24 hours in duration may also improve outcomes. The benefits of antenatal corticosteroids are additive to those derived from surfactant therapy.
What Are the Short-Term and Long-Term Adverse Effects for the Infant and Mother?
Short-Term Adverse Effects for the Infant: Short-term adverse effects of antenatal corticosteroid administration of greatest concern in the neonate include infection and adrenal suppression. The evidence presented to date shows no increase in infection in treated infants, no clinically important adrenal suppression, and rapid return of adrenal function when antenatal corticosteroids are discontinued.
Some animal studies have suggested that antenatal corticosteroid treatment might promote maladaptive responses to hypoxia. Other animal studies have shown that corticosteroids in doses similar to those used in humans antenatally provide protection against hypoxic-ischemic brain injury. More data are needed from human studies in this area of research.
Long-Term Adverse Effects for the Infant: Studies initiated in the 1970's, which followed the development of children treated antenatally with corticosteroids up to the age of 12 years, showed no adverse outcomes in the areas of motor skills, language, cognition, memory, concentration or scholastic achievement. The possibility of adverse, long-term neurodevelopmental outcomes has been suggested by studies of corticosteroid administration in animals. These studies were conducted using doses approximately 10 times the doses used in human clinical trials. There does not seem to be an increased risk in children of long-term neurodevelopmental impairment as reflected in any greater prevalence of learning, behavioral, motor, or sensory disturbances. Long-term effects of antenatal corticosteroids on growth and the onset of puberty are not fully known.
Short- and Long-Term Adverse Maternal Effects: Maternal pulmonary edema can occur when antenatal corticosteroids are used in combination with tocolytic agents. This complication is more commonly associated with maternal infection, fluid overload, and multiple gestation. Pulmonary edema has not been reported when antenatal corticosteroids are used alone.
The risk of maternal infection may be increased when corticosteroids are used in preterm premature rupture of membranes (PPROM), however, the degree of this effect, if any, is unclear. Furthermore, there is no evidence that antenatal corticosteroid treatment interferes with the ability to diagnose maternal infection. When corticosteroids are administered to pregnant diabetic women, diabetic control may become more difficult and insulin may have to be adjusted accordingly. Screening for gestational diabetes may similarly be affected. In serious maternal medical conditions that necessitate premature delivery, the delay necessary to demonstrate maximal corticosteroid effects for the fetus may worsen the maternal medical status. A subgroup analysis in the first randomized trial suggested that antenatal corticosteroid administration might predispose to fetal death in hypertensive women. Subsequent trials failed to demonstrate this effect. No long-term maternal adverse effects have been reported.
From The American Academy of Family Physicians: PreTerm Labor
Dexamethasone and betamethasone are the preferred corticosteroids for antenatal therapy (Table 4). Corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome and intraventricular hemorrhage in infants between 24 and 34 weeks of gestation. Strong evidence shows that neonatal benefits start at 24 hours and last up to seven days after treatment. There is not enough data to establish that clinical benefit lasts beyond seven days after treatment. The potential benefits or risks of repeated administration of corticosteroids after seven days are unknown.
No long-term maternal or neonatal adverse effects have been reported in association with the use of corticosteroid therapy.35 Maternal pulmonary edema can occur when antenatal corticosteroids are used in combination with tocolytic agents. This complication is more commonly associated with maternal infection, fluid overload and multiple gestation. Pulmonary edema has not been reported when corticosteroids are used alone.
In women with PPROM, antenatal corticosteroid therapy reduced the risk of respiratory distress syndrome. The magnitude of the reduction in this group is not as great as in women with intact membranes. In women with PPROM at less than 30 to 32 weeks of gestation, in the absence of clinical chorioamnionitis, antenatal corticosteroid use is recommended because of the high risk of intraventricular hemorrhage at this early gestational age.35 Although the risk of maternal and fetal infection may increase with corticosteroid use, the increased risk is small. There is no evidence that corticosteroid therapy interferes with the physician's ability to diagnose maternal infection.
mom to three, 4 and under.
I remember the shots really hurting when I got them for the twins. I was at home on bedrest at the time and I went into the dr office to have them done. I don't remember them hurting much with Lydie. Of course I was in the hospital on mag sulfate at the time. I already felt miserable anyway.
It's a moot point most of the time since when they're needed, you take 'em because they are the best shot at a healthier baby, but in case anyone has interest, here are the links:
mama to 4 boys - J (2005), A (2006), N (2008), and Z (2014)
For me, while it wasn't fun, it certainly wasn't as painful as people have described. Course I'm well "padded" too
Angela - wife to my gamer hubby and SAHM to Handsome 3/6/03 (~35wks), Princess 8/9/06: (33wks) - we are HELLP survivors, Bubbalicious 9/15/09 (FULL TERM!), and oops...here we go AGAIN! (June/July 2012?)
Anyways, maybe your dr. mixed up when saying they only last a week? What they do is basically increase the maturity of baby's lungs by approximately a week.
I had PPROM at 32wks and got the steroid shots. I delivered 33wks and 1 day and ds spent 7hrs on a vent and then went to room air. I have no doubt in my mind that the steroids helped him, and I would do it again in a heartbeat.
I don't really understand the thought that they only last for 7 days. My understanding of the betamethasone is that it causes the lungs to mature to a point where they begin to produce surfactant in greater amounts. Once the lungs start producing surfactant in high quantities on their own, they won't stop - so it's not like the shots will only cause th elungs to produce the surfactant for a limited time. When we talk about immature lungs, it's really that they aren't producing surfactant (which is the substance that makes the lungs not stick to themselves) Anyway, in my case, I do think that getting the steroids earlier with #4 made a big difference in his lung maturity. I got them around 28 weeks, adn he had absolutely no breathing issues at all after birth. With #3, who I got the shots 26 hours before he was born (the second shot was 26 hours before, exactly) he needed a dose of surfactant and was on cpap for a few days.
As for the efficacy of steroids, if they are given the 24-48 hour period needed to work, the difference in babies who had steroids versus those who did not in the NICU is dramatic. Babies who had steroids 24-48 hours prior to birth tend to need much less respiratory support.
My son was vented for only 3 days, unheard of around here for a 26 weeker boy. he was on oxygen for 4 weeks, but only at about 23% for most of that.
I would get them again in a heartbeat.
I didn't deliver for another 2 weeks, and I have often wondered how much the shots helped at that point. I know my OB did the right thing by giving them to me when he did - I was dilating and contracting and who knew what would happen? But I think they did wear off by the time my girls were born, because Kate had to be intubated for almost 2 weeks and Lilly was on a CPAP for about as long as that. Actually, sometimes I think "darn, I guess the steroids wore off" and sometimes I think "well thank goodness they got the steroids - what would've happened without them?" No way to tell
I think the shots helped, but so did the stress in the womb of 3 babies and my pre-eclampsia.
Jennifer, LPN and nursing student, Doula, CPST, and VBAC mama x3 to
AJ (5/03), Evan (12/04), Ilana (11/06), Olivia (2/09), and Unity (8/2012)