The need to go beyond: evaluating antenatal corticosteroid trials with long-term outcomes.

A single course of antenatal corticosteroids (ACS) reduces the risk of severe neonatal morbidity and is associated with a strong trend towards a reduced risk of abnormal neurodevelopmental outcome. However, because 50% of women given ACS remain undelivered and continue to be at risk for preterm delivery, the question remains: would these women benefit from repeated courses of ACS, and, if so, how do repeated courses of ACS affect the fetus and long-term neurodevelopmental outcome? The serious consequences of this effect on the developing brain justify the need for long-term outcome studies (beyond two years of age) before repeat courses of ACS become standard care in the management of pregnant women who are at risk of preterm delivery throughout pregnancy.