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

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