Repeat Antenatal Steroids Trial
- Conditions
- Complications, Pregnancy
- Registration Number
- NCT00015002
- Lead Sponsor
- The George Washington University Biostatistics Center
- Brief Summary
A course of steroids given to a mother who is in labor with a premature fetus will reduce the risk of the premature infant dying or having serious complications. This trial will test whether more than one course of antenatal steroids is more beneficial or risky to the infant than a single course.
- Detailed Description
After the NICHD Consensus Development Conference in 1994, the antenatal administration of antenatal corticosteroids (betamethasone or dexamethasone) for prevention of death and the serious morbidities associated with preterm birth has become an accepted standard in American obstetric practice. Studies have shown that maximum beneficial effect occurs when the fetus is delivered within 7 days of antenatal steroid administration. The efficacy and safety of a single course of corticosteroids has been substantiated but it is unknown whether repetitive dosing has similar efficacy or what the maternal, fetal and neonatal risks are. Repeat courses of steroids are often administered. Two popular regimens exist for the patient who remains undelivered more than one week after initial therapy but who remains at risk for preterm birth. In one, steroids are repeated weekly until 34 weeks gestation, while in the other, steroids are only given once.
This multicenter trial is testing the safety and efficacy of weekly administration of antenatal steroids. Twenty four hundred women \< 32.0 weeks gestation who are at risk for spontaneous preterm delivery and remain pregnant at least seven days after an initial course of corticosteroids are being randomized to either weekly courses of masked study drug (betamethasone or placebo) for 4 weeks or delivery, whichever comes first. Patients are asked about side effects at the weekly visits and samples of maternal blood at randomization and delivery are collected. Cord blood and placentas are also collected. Cranial ultrasounds are done on all neonates. On a subgroup of patients, an adrenocorticotrophic hormone (ACTH) stimulation test is being performed and an auditory brainstem response (ABR) performed. All infants attend a follow-up visit at 18 to 22 months corrected age where certified examiners, masked to study group assignment, collect physical and neurological data. The Bayley Scales of Infant Development will also be administered. A subgroup of infants will be seen at 36 months to administer the Intelligence scale from the McCarthy Scales of Children's Abilities.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- Female
- Target Recruitment
- 486
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Primary Outcome Measures
Name Time Method Composite outcome: including neonatal mortality/stillbirth, severe RDS, chronic lung disease, grade III/IV IVH, PVL
- Secondary Outcome Measures
Name Time Method Neonatal morbidity Maternal morbidity Neonatal Growth parameters Infant neurological parameters
Trial Locations
- Locations (19)
Northwestern University-Prentice Hospital
🇺🇸Chicago, Illinois, United States
University of Chicago
🇺🇸Chicago, Illinois, United States
MCP Hahnamann
🇺🇸Philadelphia, Pennsylvania, United States
Forsyth Memorial Hospital, Wake Forest University School of Medicine
🇺🇸Winston-Salem, North Carolina, United States
University of North Carolina
🇺🇸Chapel Hill, North Carolina, United States
Case Western Reserve-Metrohealth
🇺🇸Cleveland, Ohio, United States
Dept of OB/GYN, Ohio State University
🇺🇸Columbus, Ohio, United States
University of Texas - San Antonio
🇺🇸San Antonio, Texas, United States
University of Tennessee
🇺🇸Memphis, Tennessee, United States
University of Texas-Houston
🇺🇸Houston, Texas, United States
University of Alabama
🇺🇸Birmingham, Alabama, United States
Dept of OB/GYN, Hutzel Hospital
🇺🇸Detroit, Michigan, United States
University of Miami
🇺🇸Miami, Florida, United States
Columbia University
🇺🇸New York, New York, United States
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
Dept of OB/GYN, Magee-Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Brown University -Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
University of Utah Medical Center
🇺🇸Salt Lake City, Utah, United States
Dept of OB/GYN, Southwestern Medical Center, University of Texas
🇺🇸Dallas, Texas, United States