Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial

Kellie E. Murphy; Mary E. Hannah; Andrew R. Willan; Sheila A. Hewson; Arne Ohlsson; Edmond N. Kelly; Stephen G. Matthews; Saroj Saigal; Elizabeth Asztalos; Susan Ross; Marie France Delisle; Kofi Amankwah; Patricia Guselle; Amiram Gafni; Shoo K. Lee; B. Anthony Armson

doi:10.1016/S0140-6736(08)61929-7

Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial

Kellie E. Murphy, Mary E. Hannah, Andrew R. Willan, Sheila A. Hewson, Arne Ohlsson, Edmond N. Kelly, Stephen G. Matthews, Saroj Saigal, Elizabeth Asztalos, Susan Ross, Marie France Delisle, Kofi Amankwah, Patricia Guselle, Amiram Gafni, Shoo K. Lee, B. Anthony Armson

Medicine

Résultat de recherche: Article › examen par les pairs

318 Citations (Scopus)

Résumé

Background: One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids would reduce neonatal morbidity and mortality without adversely affecting fetal growth. Methods: 1858 women at 25-32 weeks' gestation who remained undelivered 14-21 days after an initial course of antenatal corticosteroids and continued to be at high risk of preterm birth were randomly assigned to multiple courses of antenatal corticosteroids (n=937) or placebo (n=921), every 14 days until week 33 or delivery, whichever came first. The primary outcome was a composite of perinatal or neonatal mortality, severe respiratory distress syndrome, intraventricular haemorrhage (grade III or IV), periventricular leucomalacia, bronchopulmonary dysplasia, or necrotising enterocolitis. Analysis was by intention to treat. All patients and caregivers were unaware of the treatment given. This trial is registered as number ISRCTN2654148. Findings: Infants exposed to multiple courses of antenatal corticosteroids had similar morbidity and mortality to those exposed to placebo (150 [12·9%] vs 143 [12·5%]). Those receiving multiple doses of corticosteroids also weighed less at birth than those exposed to placebo (2216 g vs 2330 g, p=0·0026), were shorter (44·5 cm vs 45·4 cm, p<0·001), and had a smaller head circumference (31·1 cm vs 31·7 cm, p<0·001). Interpretation: Multiple courses of antenatal corticosteroids, every 14 days, do not improve preterm-birth outcomes, and are associated with a decreased weight, length, and head circumference at birth. Therefore, this treatment schedule is not recommended. Funding: Canadian Institutes of Health Research.

Langue d'origine	English
Pages (de-à)	2143-2151
Nombre de pages	9
Journal	The Lancet
Volume	372
Numéro de publication	9656
DOI	https://doi.org/10.1016/S0140-6736(08)61929-7
Statut de publication	Published - déc. 20 2008

Note bibliographique

Funding Information:
MACS was funded by the Canadian Institutes of Health Research (CIHR). CIHR had no role in the design, management, data collection, analysis, or interpretation of the data. CIHR had no role in the writing of the manuscript or in the decision to submit for publication. All authors had full access to the data. KEM had final responsibility for the decision to submit the paper for publication.

Funding Information:
We thank all participants in the MACS trial; Caroline Crowther and Ron Wapner for their collaboration and support; the members of our data safety monitoring board for their guidance; and all the staff at the Maternal, Infant and Reproductive Health Research Unit in Toronto for their dedication and hard work. MACS was supported by a grant from the Canadian Institutes for Health Research (grant number MCT 38142). The data coordinating centre was supported by grants from Sunnybrook Health Sciences Centre, Women's College Hospital and the Department of Obstetrics and Gyneacology at the University of Toronto. Betamethasone and placebo were purchased from Schering-Plough Corporation (Madison, NJ, USA) and Eminent Services Corporation (Gaithersburg, MD, USA), respectively.

ASJC Scopus Subject Areas

General Medicine

ODD de l’ONU

Cette action contribue à la réalisation des objectifs de développement durable suivants

Accès au document

10.1016/S0140-6736(08)61929-7

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Murphy, K. E., Hannah, M. E., Willan, A. R., Hewson, S. A., Ohlsson, A., Kelly, E. N., Matthews, S. G., Saigal, S., Asztalos, E., Ross, S., Delisle, M. F., Amankwah, K., Guselle, P., Gafni, A., Lee, S. K., & Armson, B. A. (2008). Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial. The Lancet, 372(9656), 2143-2151. https://doi.org/10.1016/S0140-6736(08)61929-7

Murphy, KE, Hannah, ME, Willan, AR, Hewson, SA, Ohlsson, A, Kelly, EN, Matthews, SG, Saigal, S, Asztalos, E, Ross, S, Delisle, MF, Amankwah, K, Guselle, P, Gafni, A, Lee, SK & Armson, BA 2008, 'Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial', The Lancet, vol. 372, n° 9656, pp. 2143-2151. https://doi.org/10.1016/S0140-6736(08)61929-7

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title = "Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial",

abstract = "Background: One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids would reduce neonatal morbidity and mortality without adversely affecting fetal growth. Methods: 1858 women at 25-32 weeks' gestation who remained undelivered 14-21 days after an initial course of antenatal corticosteroids and continued to be at high risk of preterm birth were randomly assigned to multiple courses of antenatal corticosteroids (n=937) or placebo (n=921), every 14 days until week 33 or delivery, whichever came first. The primary outcome was a composite of perinatal or neonatal mortality, severe respiratory distress syndrome, intraventricular haemorrhage (grade III or IV), periventricular leucomalacia, bronchopulmonary dysplasia, or necrotising enterocolitis. Analysis was by intention to treat. All patients and caregivers were unaware of the treatment given. This trial is registered as number ISRCTN2654148. Findings: Infants exposed to multiple courses of antenatal corticosteroids had similar morbidity and mortality to those exposed to placebo (150 [12·9%] vs 143 [12·5%]). Those receiving multiple doses of corticosteroids also weighed less at birth than those exposed to placebo (2216 g vs 2330 g, p=0·0026), were shorter (44·5 cm vs 45·4 cm, p<0·001), and had a smaller head circumference (31·1 cm vs 31·7 cm, p<0·001). Interpretation: Multiple courses of antenatal corticosteroids, every 14 days, do not improve preterm-birth outcomes, and are associated with a decreased weight, length, and head circumference at birth. Therefore, this treatment schedule is not recommended. Funding: Canadian Institutes of Health Research.",

author = "Murphy, {Kellie E.} and Hannah, {Mary E.} and Willan, {Andrew R.} and Hewson, {Sheila A.} and Arne Ohlsson and Kelly, {Edmond N.} and Matthews, {Stephen G.} and Saroj Saigal and Elizabeth Asztalos and Susan Ross and Delisle, {Marie France} and Kofi Amankwah and Patricia Guselle and Amiram Gafni and Lee, {Shoo K.} and Armson, {B. Anthony}",

note = "Funding Information: MACS was funded by the Canadian Institutes of Health Research (CIHR). CIHR had no role in the design, management, data collection, analysis, or interpretation of the data. CIHR had no role in the writing of the manuscript or in the decision to submit for publication. All authors had full access to the data. KEM had final responsibility for the decision to submit the paper for publication. Funding Information: We thank all participants in the MACS trial; Caroline Crowther and Ron Wapner for their collaboration and support; the members of our data safety monitoring board for their guidance; and all the staff at the Maternal, Infant and Reproductive Health Research Unit in Toronto for their dedication and hard work. MACS was supported by a grant from the Canadian Institutes for Health Research (grant number MCT 38142). The data coordinating centre was supported by grants from Sunnybrook Health Sciences Centre, Women's College Hospital and the Department of Obstetrics and Gyneacology at the University of Toronto. Betamethasone and placebo were purchased from Schering-Plough Corporation (Madison, NJ, USA) and Eminent Services Corporation (Gaithersburg, MD, USA), respectively.",

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doi = "10.1016/S0140-6736(08)61929-7",

language = "English",

volume = "372",

pages = "2143--2151",

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TY - JOUR

T1 - Multiple courses of antenatal corticosteroids for preterm birth (MACS)

T2 - a randomised controlled trial

AU - Murphy, Kellie E.

AU - Hannah, Mary E.

AU - Willan, Andrew R.

AU - Hewson, Sheila A.

AU - Ohlsson, Arne

AU - Kelly, Edmond N.

AU - Matthews, Stephen G.

AU - Saigal, Saroj

AU - Asztalos, Elizabeth

AU - Ross, Susan

AU - Delisle, Marie France

AU - Amankwah, Kofi

AU - Guselle, Patricia

AU - Gafni, Amiram

AU - Lee, Shoo K.

AU - Armson, B. Anthony

N1 - Funding Information: MACS was funded by the Canadian Institutes of Health Research (CIHR). CIHR had no role in the design, management, data collection, analysis, or interpretation of the data. CIHR had no role in the writing of the manuscript or in the decision to submit for publication. All authors had full access to the data. KEM had final responsibility for the decision to submit the paper for publication. Funding Information: We thank all participants in the MACS trial; Caroline Crowther and Ron Wapner for their collaboration and support; the members of our data safety monitoring board for their guidance; and all the staff at the Maternal, Infant and Reproductive Health Research Unit in Toronto for their dedication and hard work. MACS was supported by a grant from the Canadian Institutes for Health Research (grant number MCT 38142). The data coordinating centre was supported by grants from Sunnybrook Health Sciences Centre, Women's College Hospital and the Department of Obstetrics and Gyneacology at the University of Toronto. Betamethasone and placebo were purchased from Schering-Plough Corporation (Madison, NJ, USA) and Eminent Services Corporation (Gaithersburg, MD, USA), respectively.

PY - 2008/12/20

Y1 - 2008/12/20

N2 - Background: One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids would reduce neonatal morbidity and mortality without adversely affecting fetal growth. Methods: 1858 women at 25-32 weeks' gestation who remained undelivered 14-21 days after an initial course of antenatal corticosteroids and continued to be at high risk of preterm birth were randomly assigned to multiple courses of antenatal corticosteroids (n=937) or placebo (n=921), every 14 days until week 33 or delivery, whichever came first. The primary outcome was a composite of perinatal or neonatal mortality, severe respiratory distress syndrome, intraventricular haemorrhage (grade III or IV), periventricular leucomalacia, bronchopulmonary dysplasia, or necrotising enterocolitis. Analysis was by intention to treat. All patients and caregivers were unaware of the treatment given. This trial is registered as number ISRCTN2654148. Findings: Infants exposed to multiple courses of antenatal corticosteroids had similar morbidity and mortality to those exposed to placebo (150 [12·9%] vs 143 [12·5%]). Those receiving multiple doses of corticosteroids also weighed less at birth than those exposed to placebo (2216 g vs 2330 g, p=0·0026), were shorter (44·5 cm vs 45·4 cm, p<0·001), and had a smaller head circumference (31·1 cm vs 31·7 cm, p<0·001). Interpretation: Multiple courses of antenatal corticosteroids, every 14 days, do not improve preterm-birth outcomes, and are associated with a decreased weight, length, and head circumference at birth. Therefore, this treatment schedule is not recommended. Funding: Canadian Institutes of Health Research.

AB - Background: One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids would reduce neonatal morbidity and mortality without adversely affecting fetal growth. Methods: 1858 women at 25-32 weeks' gestation who remained undelivered 14-21 days after an initial course of antenatal corticosteroids and continued to be at high risk of preterm birth were randomly assigned to multiple courses of antenatal corticosteroids (n=937) or placebo (n=921), every 14 days until week 33 or delivery, whichever came first. The primary outcome was a composite of perinatal or neonatal mortality, severe respiratory distress syndrome, intraventricular haemorrhage (grade III or IV), periventricular leucomalacia, bronchopulmonary dysplasia, or necrotising enterocolitis. Analysis was by intention to treat. All patients and caregivers were unaware of the treatment given. This trial is registered as number ISRCTN2654148. Findings: Infants exposed to multiple courses of antenatal corticosteroids had similar morbidity and mortality to those exposed to placebo (150 [12·9%] vs 143 [12·5%]). Those receiving multiple doses of corticosteroids also weighed less at birth than those exposed to placebo (2216 g vs 2330 g, p=0·0026), were shorter (44·5 cm vs 45·4 cm, p<0·001), and had a smaller head circumference (31·1 cm vs 31·7 cm, p<0·001). Interpretation: Multiple courses of antenatal corticosteroids, every 14 days, do not improve preterm-birth outcomes, and are associated with a decreased weight, length, and head circumference at birth. Therefore, this treatment schedule is not recommended. Funding: Canadian Institutes of Health Research.

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Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial

Résumé

Note bibliographique

ASJC Scopus Subject Areas

ODD de l’ONU

Accès au document

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