Antenatal corticosteroids are currently used excessively and more stringent controls on their use should be established: <scp>FOR</scp>: The use of antenatal corticosteroids should be restricted if we are to avoid causing harm

Since the landmark trial by Liggins and Howie, antenatal corticosteroid (ACS) therapy has been a prominent therapy option for the management of imminent preterm birth. Its benefits related to enhancing pulmonary maturity are undisputable and a course of ACS is supported by many bodies for women at risk for a preterm birth between 24 and 34 weeks of gestation that is anticipated to be within 1–7 days after administration. Administration of ACS beyond this recommended window is taking place at a rapid pace. Pregnancies involving a pre-viable gestation and those at the late preterm gestation beyond 34 weeks, as well as whether additional doses should be considered, expand the extent to which a now eligible fetus/neonate will be exposed to ACS. However, ACS is not a benign medication. Concern is now arising regarding many elements involving both short-term and long-term consequences of ACS exposure, which include in utero growth suppression, fetal programming and consequences for long-term chronic disease, adverse neurodevelopmental outcomes for the neonate/infant/child, as well as potential consequences for the woman (Kemp et al. Hum Reprod Update 2015 Nov 20;pii:dmv047:1–20). Evidence supports that every effort should prolong a pregnancy until the benefits of delivery outweigh the risks of remaining in utero (Stocket al. Cochrane Database Syst Rev 2012;7:CD008968). However, the anxiety that arises regarding the effects of being born preterm has taken over and has led to a practice that a ‘one size fits all’ approach is the only and best way to address the issue of a potential preterm birth leading to a trend of suboptimal, and questionably inappropriate, treatment with ACS. The magnitude of this approach can be demonstrated by a recent study that evaluated the administration of ACS in a province of Canada where, between 1988 and 2012, over half (52%) of the women who received ACS delivered at ≥35 weeks of gestation, exposing almost 130 000 infants/children to ACS unnecessarily (Razaz et al. Obstet Gynecol 2015;125:288–96). When one considers that this is likely to be similar in other jurisdictions in developed countries, it becomes immeasurable to consider the potential consequences that this practice may have. As clinicians involved in the care of the potential mother–infant dyad, we need to carefully consider when and how ACS should be administered in women thought to be at risk for preterm birth. More efforts should be made to clearly identify how at-risk pregnancies should be identified as it relates to their risk for preterm delivery. We should avoid the ‘one size fits all’ approach and develop mechanisms that help in the assessment of potential spontaneous preterm birth. We should also re-evaluate the trend of iatrogenic late preterm births because this contributes significantly to the incidence of preterm birth and unnecessary use of ACS. Neonatologists should also review their approach in counselling our obstetric colleagues and be mindful of all of the effects of ACS so that we can minimise our contribution to the suboptimal and inappropriate use of ACS. As with all approaches, we need to be eloquent in our care in order to optimise the benefits of a treatment while minimising its risks. This is especially critical when it affects a lifetime and generations to come. Full disclosure of interests available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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