Repeat doses of antenatal steroids and hypothalamic-pituitary-adrenal axis (HPA) function

Objective This study was undertaken to compare the effects of exposure to repeated courses of antenatal steroids with those of a single course on hypothalamic-pituitary-adrenal axis function. Study Design Women at risk of premature delivery were assessed for entry into a randomized controlled trial of repeated courses of corticosteroids (ACTORDS). If a woman declined the randomized trial then consent was sought for collection of observational data. Baseline bloods for cortisol and adrenocorticotropic hormone levels were collected and in a subset of infants a metyrapone test performed. Results In the 86 studied infants, cortisol and adrenocorticotropic hormone levels did not differ between those exposed to single and repeated courses of antenatal steroids ( P = .53 and P = .15, respectively). Although cortisol levels fell in response to metyrapone ( P = .03) this response was not different between the single and repeated course groups ( P = .46). Conclusion Repeated courses of antenatal steroids do not cause important hypothalamic-pituitary-adrenal axis suppression in the neonate.