Pregnancy · Risk
Antenatal Steroids Eligibility
Antenatal corticosteroid eligibility checker per ACOG Committee Opinion 713 (2017, reaffirmed 2020), WHO 2022, and the ALPS late-preterm criteria. The single most effective intervention in modern obstetrics for improving preterm outcomes.
Last reviewed 25 May 2026
Antenatal corticosteroids — eligibility
Should I have antenatal steroids?
wk
d
Enter gestational age and answer the questions to see eligibility.
Educational tool only — not medical advice. Antenatal corticosteroids are the single most effective intervention in modern obstetrics for improving preterm outcomes — they reduce neonatal mortality by ~31 %, RDS by ~34 %, IVH by ~45 %, NEC by ~50 %, and need for respiratory support (Roberts 2017 Cochrane meta-analysis, 30 trials, 7,774 women). The decision is made by your obstetric team based on the specific clinical situation.
What does this mean?
One of the highest-impact interventions in all of medicine. Liggins & Howie’s 1972 sheep-to-clinic translation remains the standard of care 50+ years later. Two doses of betamethasone 12 mg IM 24 h apart (or dexamethasone 6 mg IM × 4 doses 12 h apart) accelerates fetal lung surfactant production and reduces every major preterm complication. The benefit window is 2–7 days after the first dose; ideally courses are completed before delivery but a single dose is still useful. 23–33+6 weeks: routine if delivery within 7 days. 34–36+6 weeks (late preterm): ALPS trial (NEJM 2016) — give if no prior course and singleton. ≥ 37 weeks or already treated: not indicated. Rescue (single) course considered if first course > 14 d ago and a new acute risk emerges; serial courses are NOT recommended due to growth-restriction risk.
Introduction
Antenatal corticosteroids (ACS) — typically betamethasone 12 mg IM × 2 doses 24h apart, or dexamethasone 6 mg IM × 4 doses 12h apart — accelerate fetal lung maturation and dramatically improve preterm neonatal outcomes when given before preterm delivery. They are the single most effective intervention in obstetrics.
This checker matches ACOG Committee Opinion 713 (2017, reaffirmed 2020) and the ALPS trial (Gyamfi-Bannerman NEJM 2016) criteria for late-preterm steroids.
Background — the evidence
The Roberts 2017 Cochrane meta-analysis pooled 30 randomised trials with 7,774 women. Antenatal corticosteroids reduced:
- Neonatal death by 31 % (RR 0.69, 95% CI 0.59-0.81).
- Respiratory distress syndrome by 34 % (RR 0.66, 0.56-0.77).
- Intraventricular hemorrhage by 45 %.
- Necrotising enterocolitis by 50 %.
- Need for mechanical ventilation in the first 48 hours.
- Need for surfactant therapy.
The Liggins original 1972 trial in New Zealand was the first randomised obstetric trial to show a major mortality benefit; every guideline since has reaffirmed the recommendation.
Eligibility rules
- GA 24+0 to 33+6 weeks + anticipated delivery within 7 days → ELIGIBLE. Strong indication for all eligible women.
- GA 34+0 to 36+6 weeks (“late preterm”) + singleton + no prior course + anticipated delivery within 7 days → ELIGIBLE per ALPS.
- GA 23+0 to 23+6 weeks (periviable) → CONSIDER with shared decision-making about planned active neonatal resuscitation.
- GA < 23 weeks or ≥ 37 weeks → NOT INDICATED.
Regimens
- Betamethasone 12 mg IM × 2 doses, 24 hours apart.
- Dexamethasone 6 mg IM × 4 doses, 12 hours apart.
WHO 2022 endorses either. Practice varies by country — betamethasone in most Western Europe and the US, dexamethasone in low- and middle-income settings. Outcomes are comparable.
Timing of benefit
- Maximum benefit 24-48 hours after first dose.
- Significant benefit persists for at least 7 days.
- Benefit declines toward baseline by 14 days.
- If delivery doesn’t occur and new acute risk emerges > 14 days later AND GA < 34 weeks, ONE rescue course (single repeat dose) may be considered (ACOG CO 713).
- Serial courses (≥ 3) are AVOIDED — associated with fetal growth restriction without additional benefit.
Side effects
Maternal
- Hyperglycaemia for ~5 days (relevant for diabetic and GDM women — glucose monitoring intensified, may need temporary insulin).
- Mild fluid retention.
- Insomnia / mood changes for some women.
- No increased rate of maternal infection or wound complications.
Fetal / neonatal
- Short-term reduction in heart-rate variability and fetal movements for 24-48 hours (expected).
- Modest increase in neonatal hypoglycaemia in the late-preterm window (ALPS) — first 12 hours glucose monitoring.
- No documented long-term adverse neurodevelopmental outcomes in large cohort studies at 5- and 10-year follow-up.
What if I’m offered steroids but don’t deliver?
About half of women given ACS for threatened preterm labour don’t actually deliver within the 7-day window. The intervention is given based on best clinical judgment at the time — it doesn’t harm if delivery doesn’t occur, and a rescue course is available later if needed. This is recognised and accepted.
Limitations
- This checker reflects ACOG / WHO / ALPS criteria — your local protocol may differ slightly.
- Periviable decisions (22+0 to 23+6) involve neonatology and family conversation, not just a checker.
- Magnesium sulphate (neuroprotection) and tocolysis (delay delivery) are separate decisions that often run in parallel.
- This is educational; the decision is made by your obstetric and neonatology team in real-time clinical context.
Sources
- ACOG. Committee Opinion 713: Antenatal Corticosteroid Therapy for Fetal Maturation. 2017 (reaffirmed 2020).
- Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017;3:CD004454.
- Gyamfi-Bannerman C, et al. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery (ALPS). N Engl J Med 2016;374:1311-20.
- World Health Organization. WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes. 2022.
- NICE NG25. Preterm labour and birth. 2015, updated 2022.
- Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972;50:515-25.
Frequently asked questions
What are antenatal corticosteroids and why give them?
Antenatal corticosteroids (ACS) are betamethasone or dexamethasone given by intramuscular injection to women at risk of preterm delivery. They cross the placenta, accelerate fetal lung maturation, and dramatically improve preterm neonatal outcomes. The 2017 Cochrane meta-analysis of 30 trials and 7,774 women found: 31 % reduction in neonatal death, 34 % reduction in respiratory distress syndrome, 45 % reduction in intraventricular hemorrhage, 50 % reduction in necrotising enterocolitis, and reduced need for ventilator support. They are the single most effective intervention in modern obstetrics.
Who is eligible?
GA 24+0 to 33+6 weeks with anticipated delivery within 7 days — strong indication, all eligible women should receive. GA 34+0 to 36+6 weeks ('late preterm') — eligible if singleton with no prior corticosteroid course, per the ALPS trial (Gyamfi-Bannerman NEJM 2016). GA 23+0 to 23+6 weeks (periviable) — consider in shared decision-making with the family, per ACOG/SMFM Obstetric Care Consensus 6. Below 23 or beyond 37 weeks — not indicated.
What's the difference between betamethasone and dexamethasone?
Both are effective. Betamethasone 12 mg IM × 2 doses 24 hours apart (standard since the original Liggins 1972 trial). Dexamethasone 6 mg IM × 4 doses 12 hours apart (equivalent efficacy in head-to-head trials; less expensive). WHO 2022 recommends either. Practice varies by country — betamethasone in most Western Europe and the US, dexamethasone in low- and middle-income countries (cheaper, more available). Outcomes are comparable.
How long does the benefit last?
Maximum benefit is 24-48 hours after the first dose. Significant benefit persists for at least 7 days. After 14 days the benefit declines toward baseline. If delivery doesn't occur within 7-14 days and new acute risk of preterm delivery develops, one RESCUE course (single repeat) may be considered (ACOG CO 713). Do NOT give serial courses — multiple courses are associated with fetal growth restriction and have not shown additional benefit.
Are there risks?
Mostly maternal and transient. Maternal hyperglycaemia for ~5 days (matters in women with diabetes or GDM — glucose monitoring intensified). Mild fluid retention. Insomnia / mood changes for some women. No increased rate of maternal infection or wound complications. Fetal: short-term reduction in heart-rate variability and reduced fetal movements for 24-48h after the first dose — expected, not concerning. Long-term: large cohort studies have shown no increase in adverse child development at 5- and 10-year follow-up.
What about the late preterm window?
The Antenatal Late Preterm Steroids (ALPS) trial (Gyamfi-Bannerman NEJM 2016, 2,827 women) found that betamethasone given to women at 34+0 to 36+6 weeks with anticipated delivery within 7 days reduced respiratory complications by 20 %. Important caveats: singletons only; no prior corticosteroid course; modest increase in neonatal hypoglycaemia (need glucose monitoring in first 12 hours). ACOG/SMFM 2016 joint statement supports ALPS-criteria use; some centres offer it routinely, others selectively.
What if delivery doesn't happen after the steroids?
About 50 % of women given ACS for threatened preterm labour don't actually deliver within 7 days. Some go on to deliver weeks later, some go to term. This isn't 'wasted' — the steroids don't cause harm in this scenario. The decision to give was based on best clinical judgment at the time. If new acute preterm risk develops more than 14 days later, a rescue course may be considered (if under 34 weeks).
Can I refuse antenatal steroids?
Yes, like any medical intervention, you can decline. But for severe preterm delivery (under 32 weeks especially), the benefit is so substantial that most parents who initially hesitate accept after the conversation. The decision is yours — your obstetric team will explain the specifics for your gestation. Refusing without alternatives is high-stakes; many centres also offer magnesium sulphate (neuroprotection) and tocolysis (delay delivery to allow steroids time to work).