Systematic review and meta-analysis of repeat corticosteroids in PPROM shows increased maternal infection risk
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Key Takeaway
Consider cautious approach to repeat corticosteroids in PPROM due to increased maternal infection risk.
This systematic review and meta-analysis examined the effects of a repeat course of corticosteroids compared to a single course in women with preterm premature rupture of membranes (PPROM). The study pooled data from 2434 participants to evaluate safety and efficacy across maternal and neonatal outcomes. The authors note that further large, well-designed randomized trials are needed to clarify safety concerns regarding repeat administration.
The analysis found that repeat corticosteroid use was associated with an increased risk of endometritis, with a relative risk of 1.63 and a 95% CI of 1.10 to 2.43. Additionally, chorioamnionitis risk increased in the mixed hours subgroup, showing a relative risk of 1.62 and a 95% CI of 1.12 to 2.36 with a p value of 0.001.
No significant differences were observed for respiratory distress syndrome, neonatal sepsis, necrotizing enterocolitis, or intraventricular hemorrhage. The authors conclude that a cautious approach is warranted due to the potential increase in maternal morbidity related to repeat corticoid use.
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View Original Abstract ↓
OBJECTIVE: A single course of antenatal corticosteroids is standard for women at risk of preterm birth, including those with ruptured membranes. The benefit of repeat courses in the setting of preterm premature rupture of membranes (PPROM) remains uncertain. This study aimed to assess the safety and effectiveness of repeat versus single course of corticosteroid in women with PPROM.
STUDY DESIGN: We searched PubMed, Cochrane, and Embase databases from inception to September 17, 2025, with no language restrictions, using the terms related to PPROM and corticosteroids. Randomized and non-randomized clinical trials enrolling women with PPROM and comparing repeat with single course were included. Studies without PPROM or comparator group were excluded. Screening and quality assessment were performed by two authors, with a third author participation in case of disagreements. Statistical analysis used Review Manager 5.4 and R studio 4.5.0, with risk ratio (RR), random effects, Cochran Q test and I-squared statistics, and sensitivity analysis. This study was registered with PROSPERO (identifier: CRD420251069007).
RESULTS: Six studies comprising 2,434 patients were included. Sensitivity analysis showed that repeat course of corticosteroids increased the risk of endometritis compared to a single course (RR = 1.63; 95% CI: 1.10 to 2.43). In the subgroup analysis the mixed hours corticosteroid favored the outcome of chorioamnionitis (RR = 1.62; 95% CI: 1.12 to 2.36; = 0.001) with no overall subgroup difference. No difference was observed for the outcomes of respiratory distress syndrome, neonatal sepsis, necrotizing enterocolitis, and intraventricular hemorrhage.
CONCLUSION: Repeat corticosteroid courses in PPROM may increase maternal infections morbidity without clear neonatal benefit. Further large, well-designed randomized trials are needed to clarify safety.
KEY POINTS: · Repeat course of corticosteroid might increase maternal infections morbidity.. · A cautious approach due to potential increase in maternal morbidity related to repeat corticoid use.. · No significant neonatal benefit was observed with repeat courses of antenatal corticosteroids..
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