Treatment of Preterm Labor: Steroids & Antibiotics Health Article

In addition to giving tocolytic medicines for preterm labor, your doctor may also prescribe steroids to improve the baby's lung function. If your bag of water has broken, you may also be given antibiotics to prevent infection and help you stay pregnant longer.

Corticosteroids

If you deliver before 34 weeks, receiving corticosteroid injections can greatly improve your baby's chances of doing well. This discovery is one of the most important recent advances in caring for pregnant women in the .

Steroids are usually injected into one of the mother's large muscles (arms, legs, or buttocks). The injections are given two to four times over a two-day period, depending on which steroid is used. The most common steroid, betamethasone (Celestone), is given in two doses, 12 mg each, 12 or 24 hours apart. The medications are most effective from two to seven days after the first dose. Corticosteroids are not the same as the body-building steroids used by athletes, and multiple studies have shown that they are very safe for mothers and babies.

What Are the Benefits of Steroids?

Steroid treatment reduces the risk of lung problems for babies who are born early, particularly for those born between 29 and 34 weeks of pregnancy. Babies born more than 48 hours, but less than seven days from the first dose of steroids, show the greatest benefit The steroid treatment cuts the risk of lung disease in half and reduces a premature baby's risk of dying by 40%. All babies born at less than 28 weeks had lung problems, but the problems were milder for those who got steroids before birth. Steroids may help reduce other complications in the baby. Studies have shown that some babies have fewer problems with their intestines and with bleeding in the brain when their mothers received a course of betamethasone prior to birth.

If you are admitted to the hospital in preterm labor, or if you have a medical problem that your doctors worry will require an early delivery, you will probably be offered a course of steroids. Staying pregnant for those first two days is the first major milestone for you and your baby (or babies).

What Are the Risks of Taking Steroids?

Studies in animals have shown that giving steroids to a pregnant female can affect the immune system, neurological development, and growth of her offspring. However, these effects have shown up only in studies where steroids were given early in the pregnancy. In the treatment of preterm labor, steroids are given later in pregnancy.

Human studies have not shown any significant risks associated with a single course of steroids. One study followed infants whose mothers were given steroids during pregnancy until the children were twelve years old. These studies showed no adverse effects from the steroids on the child's physical growth or development. Still, more studies need to be done. In the past, women at risk for preterm delivery received steroids once a week until they delivered. Data from infants and animal studies showed that multiple courses of steroids were linked to babies with lower birth weights and smaller heads. Currently, repeat doses are not recommended, unless you are participating in a research study.

Who Should Take Steroids?

In 1994, the National Institutes of Health (NIH) published guidelines on the administration of steroids to women with preterm labor. According to these guidelines, doctors should consider giving steroids to all women who

• are at risk for preterm delivery between 24 and 34 weeks of pregnancy or
• receive medications to help stop labor (tocolytic medications).

Who Should Not Take Steroids?

Women with active or suspected infection in the womb (chorioamnionitis) should not receive steroids. Steroids may make diabetes (both long-standing and pregnancy-related) more difficult to control. When given in combination with a beta-mimetic drug (terbutaline), they can be even more problematic. Women with diabetes will require careful blood sugar monitoring for three to four days after receiving steroids.

Antibiotics

Antibiotics are routinely given to women in preterm labor when the bag of water surrounding the fetus has broken. This is because ruptured membranes put a woman and her baby at greater risk for infection. Many large, well-designed studies have shown that antibiotics reduce risks to mothers and babies and prolong pregnancy after a woman's water breaks early.

On the other hand, it's unclear whether antibiotics can delay delivery for women who are in preterm labor but have not broken their water. In one very large study, for example, women with preterm labor were treated with ampicillin and erythromycin. These antibiotics didn't keep the women pregnant longer or reduce problems for their babies. Reviews combining multiple studies have also failed to show a significant advantage to using antibiotics for preterm labor. Nevertheless, two much smaller studies did suggest antibiotics could be helpful. For now, using antibiotics to help treat preterm labor remains controversial.

Antibiotics don't prolong pregnancy, but there is clear data showing that it is helpful to treat women who carry a bacteria called group B streptococcus (GBS). About one in five women will carry GBS, and babies who get infected during labor and delivery can become very sick. Most care providers test women for the bacteria about a month before their due date. The test involves taking swab samples from the lower vagina and rectum. Because it can take two or three days for test results to be returned, the general practice is to go ahead and begin treating a woman for GBS presumptively (before confirmation of infection). Most doctors think that this presumptive treatment is justified because as many as one in four women test positive for GBS. Ampicillin or penicillin are the antibiotics most commonly used for treatment.

To understand what may happen next, go to Is Early Delivery Necessary