We have read the study by McKinzie et al and wanted to congratulate the authors on this prosperous article and make some minor contributions.
Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. Antenatal corticosteroid (ACS) therapy in women at risk for preterm delivery reduces the need for respiratory support and glucose supply and respiratory complication risk in neonates, including those born preterm and at term. Notwithstanding the evidence, the concern that ACSs may have the potential to adversely affect the outcomes is largely based on animal data and studies on multiple courses of ACSs. McKinzie et al concluded that ACS therapy may have negative impacts, including increasing the risk for neonatal intensive care unit admissions and small for gestational age infants delivered at term. However, the results could be confounded by different courses of ACSs and the negative impacts of ACSs might be overestimated because of comorbidities. Moreover, an investigation of the long-term outcomes should be considered.
Preterm birth is strongly associated with adverse outcomes for the neonate. Despite the fact that the prediction of preterm labor is arduous, it is still an indispensable issue. There are several predictive tests that have been mentioned, including cervical length measurement by ultrasound or biomarkers such as fetal fibronectin, phosphorylated insulin-like growth factor binding protein-1, placental alpha-macroglobulin-1, and cervical acetate level. Although a single test may not help us to predict preterm birth accurately, a combination of tests is likely to improve clinical prediction and help to guide antenatal management decisions.
We advocate for optimizing the strategy because a combination of a single course of ACS and a rescue course depends on predictive tests in women diagnosed as having threatened preterm labor. The advantage of this strategy is that it could maximize the treatment effect of ACSs and avoid multiple courses of corticosteroids. Further study of this strategy may be warranted to optimize administration of ACSs in threatened preterm labor.
The authors report no conflict of interest.