{ "release_id": "15708f235d73cd42", "id": "maternal:antenatal-corticosteroids", "owner": "maternal", "kind": "intervention", "slug": "antenatal-corticosteroids", "name": "Antenatal corticosteroids", "aliases": [ "Antenatal glucocorticoids" ], "atlases": [ "maternal" ], "summary_plain": "Steroid medicines, dexamethasone or betamethasone, given by injection to a pregnant woman who is likely to give birth early. The medicine reaches the baby and helps the lungs mature, which can protect the baby's breathing after an early birth. The mother receives the medicine and the baby is the one who is meant to benefit.", "summary_technical": "Glucocorticoids given to women with a high likelihood of preterm birth. WHO 2022 recommends intramuscular dexamethasone or betamethasone, total 24 mg in divided doses (Recommendation 1.9). ACTION-I gave intramuscular dexamethasone 6 mg every 12 hours for up to four doses, against placebo, in 29 hospitals in five low-resource countries. The recipient is the woman and the outcome of interest is the infant's, so each claim on this page states both.", "editorial_state": "draft", "last_substantive_edit": "2026-10-12", "last_evidence_check": null, "next_review_due": null, "external_ids": [], "navigation": { "maternal": { "life-stage": [ "pregnancy" ] } }, "payload": { "subtype": "medicine", "mechanism": "Per WHO 2022, the glucocorticoid crosses the placenta and helps the fetal lungs mature, including faster production of surfactant, which can prevent breathing-related illness and death in preterm newborns.", "taxonomy_codes": [] }, "content_digest": "b24df871d943bb6769dcd427e777dd606451acf793f06ebcddb8b13ad2050864", "review": { "content_digest": "b24df871d943bb6769dcd427e777dd606451acf793f06ebcddb8b13ad2050864", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "15708f235d73cd42", "id": "maternal:claim-action-i-maternal-infection", "owner": "maternal", "subject_entity_id": "maternal:antenatal-corticosteroids", "category": "safety", "statement": "In ACTION-I, possible maternal bacterial infection (defined as maternal fever of 38 degrees C or more, or clinically suspected or confirmed infection, for which therapeutic antibiotics were used) occurred in 68 of 1416 women (4.8%) given dexamethasone and 89 of 1412 (6.3%) given placebo (relative risk 0.76, 95% CI 0.56 to 1.03). The trial tested whether dexamethasone was not worse than placebo on this outcome, with a prespecified margin of 1.25 on the relative scale, and the result was consistent with that.", "context": { "id": "maternal:ctx-action-i-women-26w0d-33w6d", "label": "Pregnant women at risk of imminent preterm birth at 26w0d to 33w6d, in 29 hospitals in five low-resource countries (ACTION-I)", "recipient": "maternal", "population": "Pregnant women with a confirmed live fetus, single or multiple pregnancy, who were at risk of preterm birth between 26 weeks 0 days and 33 weeks 6 days of gestation and whose birth was planned or expected within 48 hours. Gestational age came from the earliest ultrasound or one done at admission.", "care_setting": "Hospital-based: 29 secondary- and tertiary-level hospitals across six study sites. The hospitals were chosen after a standard assessment so that the WHO conditions for antenatal corticosteroid use could reasonably be met.", "geography": "Bangladesh, India, Kenya, Nigeria and Pakistan", "life_stage": "Pregnancy, from randomization to birth, with maternal infection followed to 28 days after birth", "gestational_age_min_days": 182, "gestational_age_max_days": 237, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "The maternal primary outcome, possible maternal bacterial infection, ran from randomization to 28 days postpartum and was captured during hospital admission only.", "eligibility": { "inclusion": [ "Live fetus, single or multiple pregnancy", "Gestational age 26 weeks 0 days to 33 weeks 6 days", "Birth planned or expected in the next 48 hours", "Written informed consent before randomization" ], "exclusion": [ "Clinical signs of severe infection", "Major congenital fetal anomalies", "Systemic glucocorticoid use now or within the past two weeks", "Participation in another trial", "Contraindication to steroids", "Clinical suspicion or evidence of chorioamnionitis (registry criteria only; the paper lists clinical signs of severe infection)", "No earlier ultrasound estimate of gestational age and an immediate ultrasound not possible (registry criteria only; both ANZCTR and CTRI via ICTRP list it, and the paper says gestational age came from the earliest ultrasound or one done at admission)" ] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "This is one prespecified maternal outcome, counted during hospital admission only, in these hospitals and this population. It does not show that antenatal corticosteroids are safe in general, or in places that cannot meet the WHO conditions. The interval includes 1.00, so the data do not show a lower infection risk with dexamethasone. The same trial limits apply: hospitals chosen to meet WHO conditions, early stopping for benefit, and the Author Final Manuscript read in place of the version of record.", "editorial_state": "draft", "checked_at": null, "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, RESULTS, sentence 4 (continued)", "applicability_note": "Abstract of the primary report.", "snapshot": { "id": "maternal:pubmed-33095526-2026-10-11", "retrieved_at": "2026-10-11T19:10:30Z", "content_hash": "adb2579c89c865461eb3f3ace681a011868a4f43b15a028d7178d08ad0d7057e", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 2, row Possible maternal bacterial infection", "applicability_note": "Author Final Manuscript (CC BY); not checked against the version of record.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Study outcomes, para 1", "applicability_note": "Definition of the outcome.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Statistical analysis, para 1", "applicability_note": "Non-inferiority margin.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Table 2, footnote on possible maternal bacterial infection", "applicability_note": "Captured during hospital admission only.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } } ], "review": { "content_digest": "759824bb4d307b747e994289b1834966e89db543102193537f0343241a5c5e6a", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-action-i-maternal-infection.json" }, { "release_id": "15708f235d73cd42", "id": "maternal:claim-action-i-neonatal-death", "owner": "maternal", "subject_entity_id": "maternal:antenatal-corticosteroids", "category": "effect", "statement": "In the ACTION-I trial, pregnant women at risk of imminent preterm birth, from 26 weeks 0 days to 33 weeks 6 days of pregnancy, received either dexamethasone or a dummy injection. Fewer of their liveborn babies died in the first 28 days of life in the dexamethasone group: 278 of 1417 (19.6%) against 331 of 1406 (23.5%) in the placebo group (relative risk 0.84, 95% CI 0.72 to 0.97). The medicine was given to the mother, and the outcome counted here is the baby's.", "context": { "id": "maternal:ctx-action-i-liveborn-infants", "label": "Liveborn infants of women randomized at 26w0d to 33w6d, followed to 28 completed days of life (ACTION-I)", "recipient": "newborn", "population": "Liveborn infants of the randomized women. The window of 26 weeks 0 days to 33 weeks 6 days is the mother's gestational age when she entered the trial. It does not limit the infant's gestational age at birth, and the research gives no such limit. Birth occurred before 37 weeks for 90.0% of infants in the dexamethasone group and 90.8% of infants in the placebo group.", "care_setting": "Hospital-based: 29 secondary- and tertiary-level hospitals across six study sites. The hospitals were chosen after a standard assessment so that the WHO conditions for antenatal corticosteroid use could reasonably be met.", "geography": "Bangladesh, India, Kenya, Nigeria and Pakistan", "life_stage": "Neonatal period, birth to 28 days", "gestational_age_min_days": null, "gestational_age_max_days": null, "postnatal_age_min_days": 0, "postnatal_age_max_days": 0, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Infants entered the analysis at birth and were followed until 28 days after birth or death, whichever came first. Neonatal death means death of a liveborn within 28 completed days of life. The postnatal age bounds give age at entry, not the length of follow-up.", "eligibility": { "inclusion": [ "Liveborn infant of a woman randomized in ACTION-I" ], "exclusion": [] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "One placebo-controlled trial in 29 secondary- and tertiary-level hospitals in five low-resource countries. The hospitals were chosen so that the WHO conditions for steroid use could reasonably be met, so the result does not describe lower-level facilities or the community. The trial stopped early for benefit, short of its planned sample. About 90% of the infants were born before 37 weeks. The authors report that 45% of women received fewer than four doses, and name the difficulty of standardizing care across sites and the use of third-trimester ultrasound to confirm gestational age for many participants as limits. The relative risk is model-based, adjusted for site and for multiple births, with intervals adjusted for multiplicity. Figures come from the PubMed abstract and the Author Final Manuscript; the version of record was not fetched (HTTP 403) and the figures were not checked against it.", "editorial_state": "draft", "checked_at": null, "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, RESULTS, sentence 3", "applicability_note": "Abstract of the primary report; the same infants and time window as this context.", "snapshot": { "id": "maternal:pubmed-33095526-2026-10-11", "retrieved_at": "2026-10-11T19:10:30Z", "content_hash": "adb2579c89c865461eb3f3ace681a011868a4f43b15a028d7178d08ad0d7057e", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 2, row Neonatal death", "applicability_note": "Author Final Manuscript (CC BY); not checked against the version of record.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Table 2, footnote", "applicability_note": "The relative risk is modelled and the intervals are adjusted for multiplicity.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Study outcomes, para 1", "applicability_note": "Defines neonatal death for this trial.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Discussion, para 1", "applicability_note": "The benefit was seen even though many women received fewer than four doses.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Study setting, para 1", "applicability_note": "Hospitals were selected so that the WHO treatment criteria could reasonably be met.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } } ], "review": { "content_digest": "d10216b9960dc5f3ea55048191216ec4c3a29fb4847d83d10adbe7c90dbd68c4", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-action-i-neonatal-death.json" }, { "release_id": "15708f235d73cd42", "id": "maternal:claim-action-i-stillbirth-or-neonatal-death", "owner": "maternal", "subject_entity_id": "maternal:antenatal-corticosteroids", "category": "effect", "statement": "In ACTION-I, 393 of 1532 fetuses and infants (25.7%) in the dexamethasone group were stillborn or died as newborns, against 444 of 1519 (29.2%) in the placebo group (relative risk 0.88, 95% CI 0.78 to 0.99). The trial defined this as one count across the fetal period after enrolment and the first 28 completed days of life, and the atlas does not split it into fetal and newborn parts.", "context": { "id": "maternal:ctx-action-i-fetuses-and-infants", "label": "All fetuses of randomized women and the infants born of them, to 28 completed days of life (ACTION-I)", "recipient": "mixed", "population": "Every fetus of a randomized woman and the infants born of them, fetal and newborn together, because the trial defined stillbirth or neonatal death as one composite. The 26 weeks 0 days to 33 weeks 6 days window is the mother's gestational age at entry. Use this context only for that composite.", "care_setting": "Hospital-based: 29 secondary- and tertiary-level hospitals across six study sites. The hospitals were chosen after a standard assessment so that the WHO conditions for antenatal corticosteroid use could reasonably be met.", "geography": "Bangladesh, India, Kenya, Nigeria and Pakistan", "life_stage": "Fetal period after enrolment and neonatal period, to 28 completed days of life", "gestational_age_min_days": null, "gestational_age_max_days": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "From randomization to 28 completed days of life.", "eligibility": { "inclusion": [ "Fetus of a woman randomized in ACTION-I, and the liveborn infant it became" ], "exclusion": [] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "limitations": "The composite mixes fetal and newborn deaths and is shown as the trial defined it. The authors report no impact on stillbirth alone, which was a secondary outcome whose results were not corrected for multiple comparisons. The other limits of the neonatal death claim apply: hospitals chosen to meet WHO conditions, early stopping for benefit, and the Author Final Manuscript read in place of the version of record.", "editorial_state": "draft", "checked_at": null, "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, RESULTS, sentence 4", "applicability_note": "Abstract of the primary report.", "snapshot": { "id": "maternal:pubmed-33095526-2026-10-11", "retrieved_at": "2026-10-11T19:10:30Z", "content_hash": "adb2579c89c865461eb3f3ace681a011868a4f43b15a028d7178d08ad0d7057e", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 2, row Any baby death", "applicability_note": "Author Final Manuscript (CC BY); not checked against the version of record.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Study outcomes, para 1", "applicability_note": "The trial calls this outcome any baby death.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Outcomes, Primary outcome 2, Timepoint", "applicability_note": "ANZCTR definition of the composite.", "snapshot": { "id": "maternal:anzctr-actrn12617000476336-2026-10-11", "retrieved_at": "2026-10-11T19:10:33Z", "content_hash": "d43f7def2bdadf8c303488d8b03f6500f3786ed227e6232872ca447906b69d98", "source_effective_date": "2021-03-22", "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-anzctr", "source_type": "registry", "title": "The WHO ACTION-I (Antenatal CorticosTeroids for Improving Outcomes in preterm Newborns) Trial", "canonical_url": "https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617000476336", "identifier_namespace": "anzctr", "identifier_value": "ACTRN12617000476336", "publication_date": null, "publisher": "Australian New Zealand Clinical Trials Registry", "edition": "Record as last updated 2021-03-22 (22/03/2021 on the page). Registered 2017-03-31 (31/03/2017) and marked as prospectively registered. Dates on the page are day/month/year.", "reuse_basis": "Short factual extraction. The page states that all rights are reserved and lists personal contact data, so its bytes were not saved. Public text is cite_only (fact-check decision of 2026-10-13): the page states all rights reserved, so public pages state the facts in the atlas's own words, with a citation and a link. Numbers and dates still bind through the quote table.", "public_text": "cite_only" } }, { "evidence_role": "context", "locator": "Discussion, para 1", "applicability_note": "Stillbirth alone showed no effect.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Statistical analysis, para 3", "applicability_note": "Secondary outcomes are not corrected for multiple comparisons.", "snapshot": { "id": "maternal:pmc-pmc7660991-2026-10-11", "retrieved_at": "2026-10-11T19:10:31Z", "content_hash": "8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:action-i-nejm-2020", "source_type": "publication", "title": "Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries", "canonical_url": "https://doi.org/10.1056/NEJMoa2022398", "identifier_namespace": "doi", "identifier_value": "10.1056/NEJMoa2022398", "publication_date": "2020-12-24", "publisher": "Massachusetts Medical Society (N Engl J Med 383(26):2514-2525)", "edition": "Version of record not fetched (HTTP 403 on 2026-10-11). The abstract comes from PubMed and the bibliographic data from Crossref. Full-text facts come from the PMC Author Final Manuscript PMC7660991. Tables and figures were read in that manuscript and not checked against the version of record. PubMed lists comments and letters on the article but no erratum or retraction.", "reuse_basis": "Bibliographic metadata and short factual extraction. The PMC Author Final Manuscript states that it is licensed for use under the CC BY license and is committed at research/snapshots/ma-pmc-PMC7660991.xml. Attribution: WHO ACTION Trials Collaborators, N Engl J Med 2020;383:2514-2525, doi:10.1056/NEJMoa2022398, Author Final Manuscript via PMC (PMC7660991). The version of record is not redistributed.", "public_text": "quote" } } ], "review": { "content_digest": "1f8c1521e99e7ce39f3a23e996daa60800f79a4ef7bea9c29439373c99712b48", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-action-i-stillbirth-or-neonatal-death.json" }, { "release_id": "15708f235d73cd42", "id": "maternal:claim-who-2022-acs-1-0", "owner": "maternal", "subject_entity_id": "maternal:antenatal-corticosteroids", "category": "recommendation", "statement": "WHO recommends antenatal corticosteroid therapy for women with a high likelihood of preterm birth from 24 weeks to 34 weeks of gestation, but only when five conditions are met: gestational age can be assessed accurately, preterm birth is highly likely within 7 days of starting treatment, there is no clinical evidence of maternal infection, adequate childbirth care is available (including capacity to recognize and safely manage preterm labour and birth), and the preterm newborn can receive adequate care, including resuscitation, kangaroo mother care, thermal care, feeding support, infection treatment and respiratory support including continuous positive airway pressure (CPAP) as needed. WHO introduces that list with the word including, so the items are examples of adequate newborn care and the list is not complete. WHO's Remarks add that antenatal corticosteroids should not be routinely given where ultrasound for gestational age assessment cannot be performed. WHO classes this as a context-specific recommendation, from its 2022 update that replaced its 2015 advice. The woman is treated and the newborn is the intended beneficiary.", "context": { "id": "maternal:ctx-who-2022-acs-women-24w0d-34w0d", "label": "Women with a high likelihood of preterm birth from 24 weeks to 34 weeks of gestation, when five conditions are met (WHO 2022, Recommendation 1.0)", "recipient": "maternal", "population": "Women with a high likelihood of preterm birth within 7 days of starting therapy, from 24 weeks to 34 weeks 0 days of gestation. The woman receives the treatment and the preterm newborn is the intended beneficiary. The recommendation sets the lower limit at 24 weeks, and the Remarks set 34 weeks 0 days as the upper limit.", "care_setting": "Health-care facilities that can meet the five conditions, including accurate gestational age assessment, adequate childbirth care and adequate care of the preterm newborn. The Remarks say harm cannot be excluded where the conditions cannot be met, such as lower-level health facilities and the community level. They also say antenatal corticosteroids should not be routinely administered where ultrasound for gestational age assessment cannot be performed.", "geography": "Global (WHO guideline; no country is excluded, but the conditions must be met)", "life_stage": "Pregnancy", "gestational_age_min_days": 168, "gestational_age_max_days": 238, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Gestational age can be assessed accurately", "High likelihood of preterm birth within 7 days of starting therapy", "No clinical evidence of maternal infection", "Adequate childbirth care is available, including capacity to recognize and safely manage preterm labour and birth", "The preterm newborn can receive adequate care, including resuscitation, kangaroo mother care, thermal care, feeding support, infection treatment and respiratory support including continuous positive airway pressure (CPAP) as needed. WHO introduces the list with the word including, so it gives examples" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "WHO's four recommendation categories are not GRADE strong or conditional labels. WHO rates certainty for each outcome with GRADE and gives no single certainty rating for a recommendation, so certainty is not assessed here. The Remarks say harm cannot be excluded where the conditions cannot be met, such as lower-level health facilities and the community level. The guideline group chose 34 weeks 0 days as the upper limit because of uncertainty in the balance of benefit and harm at later gestational ages. WHO says the recommendations may be updated when new evidence appears. On 2026-10-11 title searches of WHO IRIS found no later WHO antenatal corticosteroid guideline; that is a search result, not proof of absence.", "editorial_state": "draft", "checked_at": null, "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Recommendation 1.0, PDF p. 19", "applicability_note": "WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Recommendation 1.0, conditions, PDF p. 19", "applicability_note": "WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 1, PDF p. 10 (printed p. viii), category column", "applicability_note": "The category WHO assigns.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.0, Remarks, upper limit", "applicability_note": "Why 34 weeks 0 days is the upper limit.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.0, Remarks, ultrasound for gestational age, PDF p. 19", "applicability_note": "Not to be given routinely where ultrasound dating cannot be done.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.0, Remarks, harms", "applicability_note": "Harm cannot be excluded where the conditions are not met.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "6. Updating the recommendations, PDF p. 30", "applicability_note": "The guideline may be updated.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "2.8.2 Assessment of certainty of the effectiveness evidence, PDF p. 16", "applicability_note": "WHO rates certainty for each outcome, not for each recommendation.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Overview, para 1", "applicability_note": "The 2022 recommendations replace the 2015 advice.", "snapshot": { "id": "maternal:who-pub-9789240057296-2026-10-11", "retrieved_at": "2026-10-11T19:10:36Z", "content_hash": "4fbf23c4d5cd064761bd038cfdf803e37c68411ff8024dcb45fa6ce6c0ad82a6", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } } ], "review": { "content_digest": "bd52b7f883b6f24b81e14f0d05eb077ae3c0d163ff0188fa0f463fc6c58f87c3", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-who-2022-acs-1-0.json" }, { "release_id": "15708f235d73cd42", "id": "maternal:claim-who-2022-acs-1-1", "owner": "maternal", "subject_entity_id": "maternal:antenatal-corticosteroids", "category": "recommendation", "statement": "WHO advises giving antenatal corticosteroids to women who are highly likely to give birth preterm within the next 7 days, even if the full course may not be finished before the baby is born. WHO classes this as a context-specific recommendation, and its Remarks say the five conditions of Recommendation 1.0 still apply.", "context": { "id": "maternal:ctx-who-2022-acs-women-24w0d-34w0d", "label": "Women with a high likelihood of preterm birth from 24 weeks to 34 weeks of gestation, when five conditions are met (WHO 2022, Recommendation 1.0)", "recipient": "maternal", "population": "Women with a high likelihood of preterm birth within 7 days of starting therapy, from 24 weeks to 34 weeks 0 days of gestation. The woman receives the treatment and the preterm newborn is the intended beneficiary. The recommendation sets the lower limit at 24 weeks, and the Remarks set 34 weeks 0 days as the upper limit.", "care_setting": "Health-care facilities that can meet the five conditions, including accurate gestational age assessment, adequate childbirth care and adequate care of the preterm newborn. The Remarks say harm cannot be excluded where the conditions cannot be met, such as lower-level health facilities and the community level. They also say antenatal corticosteroids should not be routinely administered where ultrasound for gestational age assessment cannot be performed.", "geography": "Global (WHO guideline; no country is excluded, but the conditions must be met)", "life_stage": "Pregnancy", "gestational_age_min_days": 168, "gestational_age_max_days": 238, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Gestational age can be assessed accurately", "High likelihood of preterm birth within 7 days of starting therapy", "No clinical evidence of maternal infection", "Adequate childbirth care is available, including capacity to recognize and safely manage preterm labour and birth", "The preterm newborn can receive adequate care, including resuscitation, kangaroo mother care, thermal care, feeding support, infection treatment and respiratory support including continuous positive airway pressure (CPAP) as needed. WHO introduces the list with the word including, so it gives examples" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "The Remarks warn against giving the treatment just in case to women who do not have a high likelihood of preterm birth. WHO's categories are not GRADE strong or conditional labels, and WHO gives no single certainty rating for a recommendation. This claim has no separate decision record in this atlas.", "editorial_state": "draft", "checked_at": null, "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Recommendation 1.1, PDF p. 20", "applicability_note": "WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 1, PDF p. 10 (printed p. viii), category column", "applicability_note": "The category WHO assigns.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.1, Remarks, PDF p. 20", "applicability_note": "No treatment just in case.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.1, Remarks, last bullet, PDF p. 20", "applicability_note": "The Remarks say the pre-conditions of Recommendation 1.0 apply.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.0, Remarks, PDF p. 19", "applicability_note": "Recommendation 1.0 applies to all the others.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } } ], "review": { "content_digest": "e27c0638e1779d8d032f64a816f05bb2afcecb205eb1f73ae8f4e8c57ca337c1", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/maternal--claim-who-2022-acs-1-1.json" }, { "release_id": "15708f235d73cd42", "id": "maternal:claim-who-2022-acs-1-4-chorioamnionitis", "owner": "maternal", "subject_entity_id": "maternal:antenatal-corticosteroids", "category": "recommendation", "statement": "WHO recommends against antenatal corticosteroid therapy for women who have chorioamnionitis and are likely to give birth preterm. Chorioamnionitis is inflammation of the membranes around the fetus (the chorion and amnion) and connected tissues, often associated with infection rising into the womb during pregnancy (MeSH definition). WHO's Remarks say timely birth should be the priority, that treatment should not be started at the expense of timely birth when the maternal or fetal condition calls for it, and that the guideline group acknowledged a concern about the risk of exacerbating maternal infection, particularly in low- and middle-income settings where the baseline risk of maternal infectious illness is higher. The group felt this potential risk may outweigh the known benefits of the steroid in the majority of populations where steroid use is essential for improving newborn survival.", "context": { "id": "maternal:ctx-who-2022-acs-chorioamnionitis", "label": "Women with chorioamnionitis who are likely to give birth preterm (WHO 2022, Recommendation 1.4)", "recipient": "maternal", "population": "Women with chorioamnionitis who are likely to give birth preterm. The recommendation text gives no gestational age bounds.", "care_setting": "Not stated in the source for this recommendation", "geography": "Global (WHO guideline)", "life_stage": "Pregnancy", "gestational_age_min_days": null, "gestational_age_max_days": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Chorioamnionitis", "Likely to give birth preterm" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "This is a narrow exception. It must be read next to Recommendation 1.0, which recommends the treatment when the conditions are met, including no clinical evidence of maternal infection. It does not mean antenatal corticosteroids are not recommended for preterm birth in general. WHO's categories are not GRADE strong or conditional labels, and WHO gives no single certainty rating for a recommendation, so certainty is not assessed here. The definition of chorioamnionitis comes from MeSH, not from the WHO guideline.", "editorial_state": "draft", "checked_at": null, "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Recommendation 1.4, PDF p. 22", "applicability_note": "WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Table 1, PDF p. 10 (printed p. viii), category column", "applicability_note": "The category WHO assigns.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.4, Remarks, timely birth", "applicability_note": "Timely birth is the priority.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.4, Remarks, not at the expense of birth", "applicability_note": "Treatment should not delay needed birth.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. 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The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.4, Remarks, risk of exacerbating maternal infection", "applicability_note": "The guideline group acknowledged a concern about the risk of exacerbating maternal infection.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. Electronic ISBN 978-92-4-005729-6; print ISBN 978-92-4-005730-2. The who.int page shows 29 September 2022 and the WHO IRIS record 10665/363131 lists an issue date of 2022-09-23; both are kept. The PDF was read from IRIS because the PDF link on the who.int page does not return the PDF.", "reuse_basis": "Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and neither the PDF nor the page is committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.4, Remarks, risk may outweigh benefits", "applicability_note": "The group felt the potential risk may outweigh the known benefits, in most populations where the steroid is essential.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. 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The non-commercial and share-alike terms need a licensing decision before any text is adapted.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Recommendation 1.4, Remarks, low- and middle-income settings, PDF p. 22", "applicability_note": "The concern is singled out for low- and middle-income settings.", "snapshot": { "id": "maternal:who-9789240057296-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:20Z", "content_hash": "5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "maternal:who-2022-acs", "source_type": "guideline", "title": "WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes", "canonical_url": "https://www.who.int/publications/i/item/9789240057296", "identifier_namespace": "isbn", "identifier_value": "978-92-4-005729-6", "publication_date": "2022-09-29", "publisher": "World Health Organization", "edition": "2022. 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