Maternal & Newborn Atlas
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Antenatal corticosteroids

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.

Also called Antenatal glucocorticoids

  • Intervention
  • In this atlas

Overview

Technical summary

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.

About this intervention

Type
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.

Claims and evidence

Context All fetuses of randomized women and the infants born of them, to 28 completed days of life (ACTION-I)

Recipient
Mixed recipients
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
Not reported
Postnatal age
Not reported
Follow-up
From randomization to 28 completed days of life.
Eligibility: 1 inclusion criterion; exclusion criteria not stated
Included
  • Fetus of a woman randomized in ACTION-I, and the liveborn infant it became
Excluded
None stated

  • Effect Interventional Certainty not assessed

    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.

    Applies to Mixed recipients
    • 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.
    • 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.
    • Bangladesh, India, Kenya, Nigeria and Pakistan
    • Fetal period after enrolment and neonatal period, to 28 completed days of life
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up From randomization to 28 completed days of life.
    Certainty method
    Not assessed
    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.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (6)

    1. Supports Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Abstract, RESULTS, sentence 4
      How it applies
      Abstract of the primary report.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      adb2579c89c865461eb3f3ace681a011868a4f43b15a028d7178d08ad0d7057e
      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.

    2. Supports Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Table 2, row Any baby death
      How it applies
      Author Final Manuscript (CC BY); not checked against the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    3. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Methods, Study outcomes, para 1
      How it applies
      The trial calls this outcome any baby death.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    4. Background The WHO ACTION-I (Antenatal CorticosTeroids for Improving Outcomes in preterm Newborns) Trial

      Registry · 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. · anzctr: ACTRN12617000476336

      Locator
      Outcomes, Primary outcome 2, Timepoint
      How it applies
      ANZCTR definition of the composite.
      Retrieved
      Source effective date
      2021-03-22
      Source state
      Current
      Snapshot hash
      d43f7def2bdadf8c303488d8b03f6500f3786ed227e6232872ca447906b69d98
      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.

    5. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Discussion, para 1
      How it applies
      Stillbirth alone showed no effect.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    6. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Methods, Statistical analysis, para 3
      How it applies
      Secondary outcomes are not corrected for multiple comparisons.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

Context 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
Not reported
Postnatal age
0 days to 0 days
Follow-up
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: 1 inclusion criterion; exclusion criteria not stated
Included
  • Liveborn infant of a woman randomized in ACTION-I
Excluded
None stated

  • Effect Interventional Certainty not assessed

    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.

    Applies to Newborn
    • 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.
    • 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.
    • Bangladesh, India, Kenya, Nigeria and Pakistan
    • Neonatal period, birth to 28 days
    • Gestational age Not reported
    • Postnatal age 0 days to 0 days
    Follow-up 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.
    Certainty method
    Not assessed
    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.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (6)

    1. Supports Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Abstract, RESULTS, sentence 3
      How it applies
      Abstract of the primary report; the same infants and time window as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      adb2579c89c865461eb3f3ace681a011868a4f43b15a028d7178d08ad0d7057e
      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.

    2. Supports Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Table 2, row Neonatal death
      How it applies
      Author Final Manuscript (CC BY); not checked against the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    3. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Table 2, footnote
      How it applies
      The relative risk is modelled and the intervals are adjusted for multiplicity.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    4. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Methods, Study outcomes, para 1
      How it applies
      Defines neonatal death for this trial.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    5. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Discussion, para 1
      How it applies
      The benefit was seen even though many women received fewer than four doses.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    6. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Methods, Study setting, para 1
      How it applies
      Hospitals were selected so that the WHO treatment criteria could reasonably be met.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

Context 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
26 weeks 0 days (182 days) to 33 weeks 6 days (237 days)
Postnatal age
Not reported
Follow-up
The maternal primary outcome, possible maternal bacterial infection, ran from randomization to 28 days postpartum and was captured during hospital admission only.
Eligibility: 4 inclusion criteria; 7 exclusion criteria
Included
  • 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
Excluded
  • 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)

  • Safety Interventional Certainty not assessed

    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.

    Applies to Maternal
    • 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.
    • 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.
    • Bangladesh, India, Kenya, Nigeria and Pakistan
    • Pregnancy, from randomization to birth, with maternal infection followed to 28 days after birth
    • Gestational age 26 weeks 0 days to 33 weeks 6 days
    • Postnatal age Not reported
    Follow-up The maternal primary outcome, possible maternal bacterial infection, ran from randomization to 28 days postpartum and was captured during hospital admission only.
    Certainty method
    Not assessed
    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.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Abstract, RESULTS, sentence 4 (continued)
      How it applies
      Abstract of the primary report.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      adb2579c89c865461eb3f3ace681a011868a4f43b15a028d7178d08ad0d7057e
      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.

    2. Supports Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Table 2, row Possible maternal bacterial infection
      How it applies
      Author Final Manuscript (CC BY); not checked against the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    3. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Methods, Study outcomes, para 1
      How it applies
      Definition of the outcome.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    4. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Methods, Statistical analysis, para 1
      How it applies
      Non-inferiority margin.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

    5. Background Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries

      Publication · 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. · Published 2020-12-24 · doi: 10.1056/NEJMoa2022398

      Locator
      Table 2, footnote on possible maternal bacterial infection
      How it applies
      Captured during hospital admission only.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      8c795f040d84bf82311862509bdde4ea0f243d2933f596c1bd4f80ebdae14b26
      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.

Context Women undergoing planned caesarean section at 34w0d to 36w6d (WHO 2022, Recommendation 1.5)

Recipient
Maternal
Population
Women undergoing a planned caesarean section at 34 weeks 0 days to 36 weeks 6 days of gestation.
Care setting
Not stated in the source for this recommendation
Geography
Global (WHO guideline)
Life stage
Pregnancy, late preterm
Gestational age
34 weeks 0 days (238 days) to 36 weeks 6 days (258 days)
Postnatal age
Not reported
Follow-up
Not applicable (recommendation context)
Eligibility: 2 inclusion criteria; exclusion criteria not stated
Included
  • Planned caesarean section
  • Gestational age 34 weeks 0 days to 36 weeks 6 days
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    WHO recommends against antenatal corticosteroid therapy for women undergoing a planned caesarean section at 34 weeks 0 days to 36 weeks 6 days of pregnancy. WHO's Remarks describe the evidence on the balance of benefits and harms for this group as scarce, and say there might be some benefits but also harms. The guideline group considered this a research priority and chose to recommend against the practice until further evidence becomes available.

    Applies to Maternal
    • Women undergoing a planned caesarean section at 34 weeks 0 days to 36 weeks 6 days of gestation.
    • Not stated in the source for this recommendation
    • Global (WHO guideline)
    • Pregnancy, late preterm
    • Gestational age 34 weeks 0 days to 36 weeks 6 days
    • Postnatal age Not reported
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    Limitations
    This is a narrow exception tied to planned caesarean birth in the late preterm period. 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 the web annex evidence tables were not fetched.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.5, PDF p. 22
      How it applies
      WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    2. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Table 1, PDF p. 10 (printed p. viii), category column
      How it applies
      The category WHO assigns.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    3. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.5, Remarks, research priority
      How it applies
      Why WHO recommends against for now.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    4. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.5, Remarks, evidence
      How it applies
      Evidence on the balance of benefits and harms is scarce.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    5. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.5, Remarks, benefits and harms, PDF p. 22
      How it applies
      There might be some benefits and also harms.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

Context 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
24 weeks 0 days (168 days) to 34 weeks 0 days (238 days)
Postnatal age
Not reported
Follow-up
Not applicable (recommendation context)
Eligibility: 5 inclusion criteria; exclusion criteria not stated
Included
  • 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
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Maternal
    • 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.
    • 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.
    • Global (WHO guideline; no country is excluded, but the conditions must be met)
    • Pregnancy
    • Gestational age 24 weeks 0 days to 34 weeks 0 days
    • Postnatal age Not reported
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    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.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (9)

    1. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.0, PDF p. 19
      How it applies
      WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    2. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.0, conditions, PDF p. 19
      How it applies
      WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    3. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Table 1, PDF p. 10 (printed p. viii), category column
      How it applies
      The category WHO assigns.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    4. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.0, Remarks, upper limit
      How it applies
      Why 34 weeks 0 days is the upper limit.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    5. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.0, Remarks, ultrasound for gestational age, PDF p. 19
      How it applies
      Not to be given routinely where ultrasound dating cannot be done.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    6. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.0, Remarks, harms
      How it applies
      Harm cannot be excluded where the conditions are not met.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    7. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      6. Updating the recommendations, PDF p. 30
      How it applies
      The guideline may be updated.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    8. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      2.8.2 Assessment of certainty of the effectiveness evidence, PDF p. 16
      How it applies
      WHO rates certainty for each outcome, not for each recommendation.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    9. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Overview, para 1
      How it applies
      The 2022 recommendations replace the 2015 advice.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      4fbf23c4d5cd064761bd038cfdf803e37c68411ff8024dcb45fa6ce6c0ad82a6
      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.

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Maternal
    • 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.
    • 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.
    • Global (WHO guideline; no country is excluded, but the conditions must be met)
    • Pregnancy
    • Gestational age 24 weeks 0 days to 34 weeks 0 days
    • Postnatal age Not reported
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    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.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.1, PDF p. 20
      How it applies
      WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    2. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Table 1, PDF p. 10 (printed p. viii), category column
      How it applies
      The category WHO assigns.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    3. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.1, Remarks, PDF p. 20
      How it applies
      No treatment just in case.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    4. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.1, Remarks, last bullet, PDF p. 20
      How it applies
      The Remarks say the pre-conditions of Recommendation 1.0 apply.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    5. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.0, Remarks, PDF p. 19
      How it applies
      Recommendation 1.0 applies to all the others.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

Context 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
Not reported
Postnatal age
Not reported
Follow-up
Not applicable (recommendation context)
Eligibility: 2 inclusion criteria; exclusion criteria not stated
Included
  • Chorioamnionitis
  • Likely to give birth preterm
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Maternal
    • Women with chorioamnionitis who are likely to give birth preterm. The recommendation text gives no gestational age bounds.
    • Not stated in the source for this recommendation
    • Global (WHO guideline)
    • Pregnancy
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    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.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (10)

    1. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, PDF p. 22
      How it applies
      WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    2. Supports WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Table 1, PDF p. 10 (printed p. viii), category column
      How it applies
      The category WHO assigns.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    3. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, Remarks, timely birth
      How it applies
      Timely birth is the priority.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    4. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, Remarks, not at the expense of birth
      How it applies
      Treatment should not delay needed birth.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    5. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, Remarks, ongoing systemic infection
      How it applies
      Also avoid with ongoing systemic infection.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    6. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, Remarks, risk of exacerbating maternal infection
      How it applies
      The guideline group acknowledged a concern about the risk of exacerbating maternal infection.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    7. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, Remarks, risk may outweigh benefits
      How it applies
      The group felt the potential risk may outweigh the known benefits, in most populations where the steroid is essential.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    8. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, Remarks, low- and middle-income settings, PDF p. 22
      How it applies
      The concern is singled out for low- and middle-income settings.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    9. Background WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes

      Guideline · 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. · Published 2022-09-29 · isbn: 978-92-4-005729-6

      Locator
      Recommendation 1.4, Remarks, majority of populations, PDF p. 22
      How it applies
      The weighing applies to the majority of populations where steroid use is essential for newborn survival.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5005890cdc3ec2531d62aefaada7e5f2a9ac8adf5d75ec94ffe35fe133fe7f20
      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.

    10. Background MeSH descriptor D002821 (Chorioamnionitis)

      Dataset · U.S. National Library of Medicine · Edition MeSH linked-data descriptor record with lastUpdated 2021-06-30, as fetched on 2026-10-12, and its preferred concept record M0004338, which holds the scope note used for the plain-language gloss of chorioamnionitis. The records state no yearly MeSH release. · mesh: D002821

      Locator
      Concept M0004338, scopeNote
      How it applies
      Plain definition of chorioamnionitis; MeSH, not WHO.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0976260c6de8346496fc8377c4da5415e48665db8f61cf74f67037f5b432fdb1
      Reuse basis
      The NLM web policies page, fetched on 2026-10-12 as ma-nlm-web-policies.html (sha256 c8b7026b5c3fcfd1b0cb88755077f6a99a5f2159eecd42b0e7d1a5ad9b30ec55), says works produced by the U.S. government are not subject to copyright protection in the United States and asks users to acknowledge NLM as the source. Source: National Library of Medicine. Only one short scope note is quoted and the bytes are not committed.

Guidance

Recommended: Antenatal corticosteroids

Applies to Maternal
  • 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.
  • 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.
  • Global (WHO guideline; no country is excluded, but the conditions must be met)
  • Pregnancy
  • Gestational age 24 weeks 0 days to 34 weeks 0 days
  • Postnatal age Not reported
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
Guideline
WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes, 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.
Strength
Context-specific recommendation (WHO guideline method with GRADE and evidence-to-decision frameworks. The guideline sorts its recommendations into four categories: recommended; not recommended; recommended only in specific contexts (context-specific recommendation); and recommended only in the context of rigorous research. These are not GRADE strong or conditional labels. WHO rates certainty for each outcome with GRADE and gives no single certainty rating for a recommendation.)
Effective
2022-09-29 (The who.int page date, 29 September 2022 (2022-09-29), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2022-09-23. Both dates are kept.)
Jurisdiction
Global. WHO guidance for national and local protocols and policies; not a regulatory authorization.
Basis
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.

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.

Recommended against: Antenatal corticosteroids

Applies to Maternal
  • Women with chorioamnionitis who are likely to give birth preterm. The recommendation text gives no gestational age bounds.
  • Not stated in the source for this recommendation
  • Global (WHO guideline)
  • Pregnancy
  • Gestational age Not reported
  • Postnatal age Not reported
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
Guideline
WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes, 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.
Strength
Not recommended (WHO guideline method with GRADE and evidence-to-decision frameworks. The guideline sorts its recommendations into four categories: recommended; not recommended; recommended only in specific contexts (context-specific recommendation); and recommended only in the context of rigorous research. These are not GRADE strong or conditional labels. WHO rates certainty for each outcome with GRADE and gives no single certainty rating for a recommendation.)
Effective
2022-09-29 (The who.int page date, 29 September 2022 (2022-09-29), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2022-09-23. Both dates are kept.)
Jurisdiction
Global. WHO guidance for national and local protocols and policies; not a regulatory authorization.
Basis
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.

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.

Recommended against: Antenatal corticosteroids

Applies to Maternal
  • Women undergoing a planned caesarean section at 34 weeks 0 days to 36 weeks 6 days of gestation.
  • Not stated in the source for this recommendation
  • Global (WHO guideline)
  • Pregnancy, late preterm
  • Gestational age 34 weeks 0 days to 36 weeks 6 days
  • Postnatal age Not reported
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
Guideline
WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes, 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.
Strength
Not recommended (WHO guideline method with GRADE and evidence-to-decision frameworks. The guideline sorts its recommendations into four categories: recommended; not recommended; recommended only in specific contexts (context-specific recommendation); and recommended only in the context of rigorous research. These are not GRADE strong or conditional labels. WHO rates certainty for each outcome with GRADE and gives no single certainty rating for a recommendation.)
Effective
2022-09-29 (The who.int page date, 29 September 2022 (2022-09-29), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2022-09-23. Both dates are kept.)
Jurisdiction
Global. WHO guidance for national and local protocols and policies; not a regulatory authorization.
Basis
WHO recommends against antenatal corticosteroid therapy for women undergoing a planned caesarean section at 34 weeks 0 days to 36 weeks 6 days of pregnancy. WHO's Remarks describe the evidence on the balance of benefits and harms for this group as scarce, and say there might be some benefits but also harms. The guideline group considered this a research priority and chose to recommend against the practice until further evidence becomes available.

Limitations. This is a narrow exception tied to planned caesarean birth in the late preterm period. 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 the web annex evidence tables were not fetched.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Record details

Record id
maternal:antenatal-corticosteroids
Content hash
b24df871d943bb6769dcd427e777dd606451acf793f06ebcddb8b13ad2050864