Antenatal corticosteroids for fetal lung development

Examples

Brand Name Chemical Name

Celestone Soluspan

How It Works

Betamethasone and dexamethasone cause an immature fetus's lungs to produce a compound called surfactant. A full-term baby's lungs
naturally produce surfactant, which lubricates the lining of the air sacs within the lungs. This allows the inner surfaces of the air sacs
to slide against one another without sticking during breathing. Premature infants whose lungs have begun producing surfactant have
an improved ability to breathe on their own, or with less respiratory treatment, after birth.

When preterm birth between 24 and 34 weeks of pregnancy (gestation) is expected within 7 days, betamethasone or dexamethasone is
given to the mother in order to affect the fetus. Betamethasone is given in 2 injections, 24 hours apart. Dexamethasone is given every
12 hours for 4 doses.

If delivery does not occur within 7 days of treatment, the injections should not be repeated.

Why It Is Used

Betamethasone and dexamethasone are corticosteroids, also called glucocorticoids, that are given before birth (antenatally) to speed up
a preterm fetus's lung development. Either is used when a mother is in preterm labor and birth may occur in 24 to 48 hours. This helps
prevent respiratory distress syndrome (RDS) and related complications following premature birth.

Many infants born at 33 to 34 weeks' gestation have sufficient lung maturity to breathe on their own. But considering the low-risk,
high-benefit nature of this treatment, corticosteroids are typically used up to 34 weeks of pregnancy.

How Well It Works

There is strong evidence that a single course of corticosteroid medicine given to the mother during premature labor improves the
outcome for the infant born between 24 and 34 weeks' gestation.1

Betamethasone or dexamethasone is most effective if delivery occurs at least 24 hours after the first dose of the medicine has been
given and less than 7 days after the last dose of the medicine.

Either medicine will benefit a premature newborn by lowering the risk of:

• Breathing problems (respiratory distress syndrome) after birth.

• Bleeding in the brain (intraventricular hemorrhage).
• Intestinal infection (necrotizing enterocolitis).
• Death.

Side Effects

Corticosteroid side effects that might affect the mother can include fluid retention and increased blood pressure. But these are short-
term side effects and less likely to occur at all during such a short period of treatment. These side effects are more of a concern during
long-term treatment for other health problems.

Control of diabetes may be more difficult in pregnant women when corticosteroids are used. Your doctor may recommend a different
insulin dose during this time.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About

Fetal lung maturity testing (using amniotic fluid collected through amniocentesis) is sometimes used to determine whether antenatal
corticosteroid treatment is necessary.

Repeat courses of corticosteroids given before birth are not recommended.2 They may cause long-term effects on the growing child.3

GENERIC NAME: betamethasone dipropionate

BRAND NAME: Diprosone; Diprolene

DRUG CLASS AND MECHANISM: Betamethasone dipropionate is a synthetic glucocorticoid that is used topically on the skin.
(The naturally-occurring glucocorticoid is cortisol or hydrocortisone which is produced by the adrenal gland.) Glucocorticoids have
potent anti-inflammatory actions and also suppresses the immune response.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Cream (0.05%), Ointment (0.05%), Topical aerosol (0.1%) Topical lotion (0.05%); Augmented Gel, Cream,
Ointment, or Lotion (0.05%; Diprolene). The augmented formulation (Diprolene) is a highly potent form of betamethasone
dipropionate which can suppress the production of hydrocortisone by the body under several circumstances. Such circumstances
include application for 7 days or longer, to broken skin, to a large part of the body, and in children.

STORAGE: All preparations should be kept between 20 and 30°C (36-86°F). Lotion should be shaken before each use.

PRESCRIBED FOR: Betamethasone dipropionate is used for the relief of itching and inflammation associated with a wide variety of
skin conditions.

DOSING: A thin strip of betamethasone dipropionate cream or ointment is applied gently to the affected area once or twice daily. A
few drops of the lotion is applied to the affected area once or twice daily. The lotion should be massaged gently until it disappears.
The augmented lotion should not be used for longer than two weeks, and not more than 50 ml should be used per week. The
augmented cream or ointment should be limited to 45 grams per week.

DRUG INTERACTIONS: There are no known drug interactions with topical betamethasone dipropionate.

PREGNANCY: When glucocorticoids are given systemically (orally, intramuscularly or intravenously) to pregnant animals, fetal
abnormalities occur. Following application to the skin, a small amount of betamethasone dipropionate is absorbed into the blood and
is distributed systemically to the rest of the body. In fact, fetal abnormalities have been noted when potent glucocorticoids are applied
to the skin of pregnant animals though betamethasone dipropionate specifically has not been studied in animals. Furthermore, there is
no data on the use of betamethasone dipropionate in pregnant women. The use of betamethasone dipropionate during pregnancy,
therefore, should be carefully considered with the potential risk weighed against the possible benefit.

NURSING MOTHERS: It is not known if betamethasone dipropionate is secreted in breast milk.

SIDE EFFECTS: The most commonly-noted side effects of betamethasone dipropionate are burning at the area of application,
itching, irritation, and dryness. All of these are unusual, however.

Topical application of glucocorticoids may suppress the body's production of cortisol. This is especially true for potent products such
as the augmented formulation of betamethasone dipropionate (Diprolene). If suppression has occurred for a long enough period of
time, discontinuing the potent glucocorticoid can be associated with symptoms of glucocorticoid deficiency. (It takes the adrenal
glands some time before they can begin producing glucocorticoids again.)

Absorption of potent glucocorticoids can increase the glucose concentration in the blood (this is especially worrisome in diabetics) and
cause symptoms of glucocorticoid excess (weight gain, redistribution of fat stores, and psychiatric problems). The suppression of
inflammation and the immune response caused by glucocorticoid excess also allows infections to occur more easily.