A Randomized Trial Comparing the Impact of One Versus Two Courses of Antenatal Steroids (ACS) on Neonatal Outcome

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Obstetrix Medical Group
ClinicalTrials.gov Identifier:
NCT00201643
First received: September 12, 2005
Last updated: September 15, 2011
Last verified: September 2011
  Purpose

The hypothesis is that administration of two courses of antenatal corticosteroids, compared to one course, will show a 40% reduction in the incidence of composite neonatal morbidity in patients delivering prior to 34 weeks' gestation.


Condition Intervention Phase
Preterm Delivery
Drug: Betamethasone or Dexamethasone (2nd course of ACS)
Drug: Placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: A Randomized Double-Blinded Study Comparing the Impact of One Versus Two Courses of Antenatal Steroids on Neonatal Outcome

Resource links provided by NLM:


Further study details as provided by Obstetrix Medical Group:

Primary Outcome Measures:
  • Composite Neonatal Morbidity < 34 Weeks Gestation at Time of Birth. [ Time Frame: From birth to 28 days of life ] [ Designated as safety issue: Yes ]
    This outcome measured the total number of neonates with Composite Neonatal morbidity who delivered at < 34 weeks gestation. Composite Morbidity consisted of respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular hemorrhage, periventricular leukomalacia, proven sepsis, necrotizing enterocolitis, or perinatal death


Secondary Outcome Measures:
  • Gestational Age at (@) Delivery [ Time Frame: gestational age at delivery in weeks of gestation ] [ Designated as safety issue: Yes ]
    Reported the average/mean Neonatal gestational age (GA) (reported in weeks of pregnancy) at the time of birth for both groups (ACS vs. Placebo).

  • Neonatal Birth Weight Reported in Grams [ Time Frame: At time of Birth ] [ Designated as safety issue: Yes ]
    Measured mean Birth weights of Neonates in each arm as reported in grams on the birth record.

  • Interuterine Growth Restriction (IUGR) or Small for Gestational Age(SGA)in Babies Delivering at < 34 Weeks Gestation. [ Time Frame: Measured at birth. ] [ Designated as safety issue: Yes ]
    Noted as the total number of Neonates delivering at < 34 weeks gestation for which their weights fell within the 10th percentile at time of birth.

  • Neonatal Head Circumference Taken at Time of Birth. [ Time Frame: Birth ] [ Designated as safety issue: Yes ]
    Reported as the average of all neonatal head circumferences (HC) taken at time of birth in each group.

  • Number of Babies Who Required Ventilatory Support Within the First 28 Days of Life. [ Time Frame: birth to 28 days of life ] [ Designated as safety issue: Yes ]
    The number of babies who required ventilatory support within the first 28 days of life. Equal to or great than 12 hours was considered one day.

  • Number of Neonates Who Required Surfactant Therapy After Birth. [ Time Frame: Birth to 28 days of life ] [ Designated as safety issue: Yes ]
    The Number of neonates who required surfactant therapy within the first 28 days after birth.

  • Number of Neonates With Pneumothorax [ Time Frame: birth to 28 days of life ] [ Designated as safety issue: Yes ]
    Total number of neonates with pneumothorax diagnosed postpartum.

  • Maternal Infectious Morbidity. [ Time Frame: Up to 28 days after giving birth ] [ Designated as safety issue: Yes ]
    Total number of Mothers having Maternal infectious morbidity (e.g. endometritis & maternal sepsis) noted from birth through 28 days after birth


Enrollment: 437
Study Start Date: November 2003
Study Completion Date: February 2008
Primary Completion Date: February 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1 Test group
Receive 2nd Course = Study drug (betamethasone or dexamethasone)
Drug: Betamethasone or Dexamethasone (2nd course of ACS)
Course of Betamethasone or Dexamethasone
Other Names:
  • Beta
  • Dex
Placebo Comparator: 2 - Control
Placebo group = received placebo course
Drug: Placebo
Course of Placebo (NS)
Other Name: Placebo, Normal Saline.

Detailed Description:

This is a randomized double-blinded placebo-controlled trial. The objective of this study is to evaluate the impact of one versus two courses of antenatal steroids on the incidence of major neonatal morbidity including respiratory distress syndrome in patients delivering prior to 34 weeks' gestation in a randomized prospective fashion.

Preterm delivery occurs in approximately 10% of all deliveries in the United States. Preterm birth is the cause of 75% of neonatal mortality not mentioning the significantly increased morbidity from respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis. Numerous studies have evaluated the safety and efficacy of antenatal corticosteroid (ACS) administration in threatened preterm labor.

National Institutes of Health (NIH) first consensus conference in 1994 evaluated the research in this field. Conclusions included the clear evidence that antenatal corticosteroids decrease the incidence of RDS in infants born at 29-34 weeks gestation, with a decrease in RDS severity for infants born at 24-28 weeks gestation and a decrease in the incidence of intraventricular hemorrhage in infants born at 24-28 weeks gestation without harm to mother or fetus. Their recommendation was to give a single course of corticosteroids to all pregnant women between 24 and 34 weeks gestation who are at risk of preterm delivery within 7 days.

Since the studies on the duration of the effects of antenatal corticosteroids in the fetus are not conclusive, many obstetricians repeat corticosteroids weekly or bi-weekly to patients continuing to be at risk for preterm delivery. Lacking scientific evidence, many investigators have performed retrospective analyses regarding the effects of single-course versus multiple-course antenatal corticosteroids.

The NIH consensus panel reconvened in 2000 and concluded that studies regarding repeated courses of corticosteroids are suggestive of possible benefits, especially in reduction of RDS, however, design flaws limit their validity.

The more recent publication from Caughey and Parer examined the literature for evidence regarding a dose response of the benefits and detriments of antenatal corticosteroids. Based on their complex mathematical analysis they recommend all fetus' between 24 and 34 weeks' gestation at risk for preterm delivery should be given a first course of ANC. If the risk of preterm delivery persists the next course should be given 2 weeks later, for a maximum of two courses. Consistent with all previous articles, the call for a well designed randomized, controlled trial is made.

  Eligibility

Ages Eligible for Study:   18 Years to 60 Years
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 25 to 32 6/7 weeks gestation
  • Singleton or twin gestation
  • Received 1st course of betamethasone prior to 30 weeks' gestation
  • Began 1st course of betamethasone at least 14 days prior to randomization
  • Risk of delivery in next 7 days due to either maternal or fetal complication (e.g. preterm labor, severe preeclampsia, IUGR, etc.)
  • Intact membranes

Exclusion Criteria:

  • Known major fetal anomalies (eg: anencephaly, renal agenesis etc…)
  • High order multiple gestation (triplets or higher)
  • Cervical dilation > 5 cm
  • Clinical chorioamnionitis prior to initiation of second course (two or more of the following; antepartum temperature > 38ºC (100.4ºF), uterine tenderness, foul smelling vaginal discharge or amniotic fluid, maternal tachycardia (>100beats/min), fetal tachycardia (>160 beats/min), or white blood cell count >20x109/L.define)
  • Ruptured membranes prior to initiation of second course of betamethasone
  • Already receiving corticosteroids for other conditions (e.g. Lupus, asthma)
  • Maternal condition contraindicating the use of steroids (e.g. HIV, active Tuberculosis)
  • Participation in conflicting study
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00201643

Locations
United States, Arizona
Desert Good Samaritan Hospital
Mesa, Arizona, United States, 85202
Banner Good Sammaritan Hospital
Phoenix, Arizona, United States, 85006
Tucson Medical Center
Tucson, Arizona, United States, 85712
United States, California
Saddleback Memorial Medical Center
Laguna Hills, California, United States, 92653
Long Beach Memorial Medical Center
Long Beach, California, United States, 90801-1428
University of Sourthern California-Irvine Medical Center
Orange, California, United States, 92868
Good Samaritan Hospital
San Jose, California, United States, 95124
United States, Colorado
Swedish Medical Center
Denver, Colorado, United States, 80110
Rose Medical Center
Denver, Colorado, United States, 80220
Presbyterian/St Luke's Hospital
Denver, Colorado, United States, 80218
Skyridge Medical Center
Lonetree, Colorado, United States, 80124
United States, Iowa
Mercy Medical Center
Des Moines, Iowa, United States, 50314
United States, Massachusetts
Tufts-New England Medical Center
Boston, Massachusetts, United States, 02111
United States, Missouri
Saint Luke's Hospital, Kansas City
Kansas City, Missouri, United States, 64111
Saint John's Regional Health Center
Springfield,, Missouri, United States, 65804
United States, Nevada
Sunrise Medical Center
Las Vegas, Nevada, United States, 89109
University Med. Ctr. of Southern Nevada
Las Vegas, Nevada, United States, 89102
United States, Tennessee
Erlanger Medical Center
Chattanooga, Tennessee, United States, 37403
University of Tennessee Medical Center
Knoxville, Tennessee, United States, 37920
United States, Utah
University of Utah Health Sciences Center
Salt Lake City, Utah, United States, 84132
United States, Washington
Evergreen Hospital
Kirkland, Washington, United States, 98034
Swedish Medical Center
Seattle, Washington, United States, 98122-4307
Sponsors and Collaborators
Obstetrix Medical Group
Investigators
Study Director: Kimberly Maurel, RN, MSN, CNS Obstetrix Medical Group, Inc.
  More Information

Additional Information:
Publications:
Responsible Party: Obstetrix Medical Group
ClinicalTrials.gov Identifier: NCT00201643     History of Changes
Other Study ID Numbers: OBX0001, OBX0001
Study First Received: September 12, 2005
Results First Received: September 7, 2010
Last Updated: September 15, 2011
Health Authority: United States: Institutional Review Board

Keywords provided by Obstetrix Medical Group:
Preterm Labor
Preterm delivery

Additional relevant MeSH terms:
Premature Birth
Obstetric Labor, Premature
Obstetric Labor Complications
Pregnancy Complications
Betamethasone-17,21-dipropionate
Dexamethasone acetate
Betamethasone
Dexamethasone
Betamethasone sodium phosphate
Dexamethasone 21-phosphate
BB 1101
Anti-Inflammatory Agents
Therapeutic Uses
Pharmacologic Actions
Anti-Asthmatic Agents
Respiratory System Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Central Nervous System Agents
Gastrointestinal Agents
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on April 14, 2014