Betamethasone: In-Utero Steroids Help Prevent Birth Injuries in Premature Babies

Premature babies are at risk for serious health problems, including respiratory distress, brain bleeds, periventricular leukomalacia (white matter brain damage), and necrotizing enterocolitis (intestinal infection). If physicians expect that an infant is going to be born preterm, they can lessen these risks by injecting the pregnant mother with a drug called betamethasone. Betamethasone can help the baby’s organs and tissues mature faster, which decreases vulnerability to the aforementioned issues and improves long-term health outcomes.


Antenatal Betamethasone and Lung Function

Betamethasone is a type of corticosteroid, which are synthetic versions of naturally-occuring hormones. In adults, corticosteroids can be used to reduce itching, swelling, and allergic reactions. Betamethasone can also be given in utero (antenatally) via an injection into the mother’s arm, leg, or buttocks; it then travels through her bloodstream and into the baby’s circulation (1). Antenatal betamethasone is primarily used to speed up lung development in preterm fetuses. It stimulates the synthesis and release of surfactant (2), which lubricates the lungs, allowing the air sacs to slide against one another without sticking when the infant breathes. Full-term babies produce enough surfactant to breathe without assistance, but premature babies often do not. Antenatal betamethasone can help to mitigate this issue, and it significantly reduces the risk of serious respiratory problems and death (3).

Other Benefits of Antenatal Betamethasone

In addition to preparing the baby’s lungs for the outside world, betamethasone reduces the risk of infant brain bleeds and a type of intestinal infection called necrotizing enterocolitis (3, 4). One meta-analysis indicated that betamethasone  could prevent brain bleeds in about six of 100 babies and necrotizing enterocolitis in about four of 100 babies (4).

Overall, antenatal betamethasone may reduce a premature infant’s chance of death by as much as 40 percent (1, 5). Moreover, it can decrease the risk of lifelong disabilities such as periventricular leukomalacia (2), cerebral palsy (CP) (6), seizures, and intellectual disabilities, among other issues.

Risks of Antenatal Betamethasone

Animal studies have shown significant risks associated with antenatal betamethasone, including hyperactivity, other behavioral abnormalities, and altered endocrine function. Moreover, in guinea pigs, it is not just the direct offspring that are affected; the consequences of betamethasone can continue on to the next generation. Researchers believe this is due to epigenetic mechanisms; in other words, changes in DNA expression that can be heritable (5, 7).

Although these findings were somewhat alarming, research on humans has indicated that when given late in pregnancy and in small doses, the risks are minimal (1, 2, 8). Women at high risk of delivering prematurely used to receive steroids once a week until their babies were born. However, studies linked multiple courses of steroids with lower birth weights and smaller heads (1, 8, 9), so repeated courses are no longer recommended, in most cases.  

When Should Betamethasone Be Given?

The American College of Obstetricians and Gynecologists (ACOG) currently makes the following recommendations regarding corticosteroid administration:

  • Women between 24-34 weeks of gestation, who are at risk of delivering a premature baby within the next week, should be given a single course of corticosteroids. In some cases, this may also be recommended for women between 23-24 weeks of pregnancy.
  • Women between 34-37 weeks of gestation, who are at risk of delivering a premature baby within the next week, can be given a single course of corticosteroids if they have not already received one.
  • Women at less than 34 weeks of gestation who are at risk of delivering a premature baby within the next week can be given a second course of course of corticosteroids if it has been more than 14 days since the first course. In some situations, physicians may recommend a second course seven days after the first (8).

Betamethasone is most effective if given between two and seven days prior to the baby’s birth (1).

Other Medical Interventions for Preterm Babies

Besides giving antenatal betamethasone, there are other things doctors may recommend in order to help a fetus that is likely to be born prematurely or a baby that already has. These interventions include:

  1. Cervical cerclage to prevent preterm birth in women with incompetent cervix
  2. Progesterone therapy to prevent preterm birth
  3. Medications to stop contractions (terbutaline and brethine)
  4. Antenatal magnesium sulfate to protect the baby from brain injuries
  5. Surfactant given to the baby after birth
  6. Careful monitoring for and prevention of infection
  7. Ventilatory and respiratory support

For more information, please visit our page on “Premature Birth and Its Prevention.”


Trusted Premature Birth AttorneysBirth Injury Attorneys | Reiter & Walsh, PC | HIE, Birth Asphyxia, Cerebral Palsy, Birth Injury Attorneys

 

Physicians, nurses, midwives, and other medical professionals are obligated to do everything in their power to prevent premature birth. This includes diagnosing potential causes of preterm birth, using betamethasone and other interventions in high-risk situations, planning for delivery, calling for emergency C-sections when needed, and providing all other means of care in accordance with a strict set of rules. The failure to properly handle or prevent premature birth is medical negligence, and when it causes a birth injury, it is medical malpractice.

If medical professionals failed to prevent or mismanaged your preterm birth, and your child has a permanent disability such as cerebral palsy, the award-winning attorneys at Reiter & Walsh ABC Law Centers can help.

We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future, and we give personal attention to each child and family we represent. Our firm has numerous multi-million dollar verdicts and settlements that attest to our success, and you pay nothing until we win your case.


“Reiter and Walsh goes above and beyond the norm in getting their clients the best possible results. Each client is treated with respect and compassion, and they are truly sensitive to what it means to help a family whose child has been injured.”

-Client review from 11/23/2015


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Sources

  1. Healthline – How Preterm Labor Adjunctive Therapy Helps
  2. Medscape – Drug Therapy During Labor and Delivery, Part 1
  3. U of M Health – Antenatal Corticosteroids for Fetal Lung Development
  4. PubMed Health – Pregnancy and birth: Before preterm birth: What do steroids do?
  5. New Scientist – Pregnancy drug can affect grandkids
  6. The American Pediatric Society and the Society for Pediatric Research – Antenatal Betamethasone and the Risk of Cerebral Palsy (CP) in Very Low Birth Weight (VLBW) Neonates
  7. Scientific Reports – Prenatal Glucocorticoid Exposure Modifies Endocrine Function and Behaviour for 3 Generations Following Maternal and Paternal Transmission
  8. ACOG – Antenatal Corticosteroid Therapy for Fetal Maturation
  9. Obstet Gynecol – Effect of antenatal corticosteroids on fetal growth and gestational age at birth