REMARKS Q Antenatal corticosteroid therapy should be started even when the completion of a full course before preterm birth is uncertain. Q The GDG acknowledges the limitations and potential biases of evidence on interval between antenatal corticosteroid administration and preterm birth as derived from subgroup analyses of trials and observational studies, but agreed that available evidence confirms there is an association between the interval from administration to birth and preterm newborn outcomes. The GDG agreed that there is sufficient evidence to support benefit when the interval between antenatal corticosteroid administration and birth is 1–7 days. However, the GDG acknowledged that there is also evidence to indicate that there may be benefits of antenatal corticosteroids within the first 24 hours, and benefit which continues beyond 7 days after the first dose. The GDG considered this broader window of administration-to-birth interval as reassuring in the context of the challenges of accurately predicting spontaneous preterm birth. Q Antenatal corticosteroids should not be administered (“just in case”) to women who do not have a high likelihood of preterm birth, due to the potential newborn harms associated with prolonged administration-to-birth intervals (for example, 3 or more weeks) or administration to women who are likely to give birth at term. Q The GDG highlighted the importance of counselling and shared decision-making regarding antenatal corticosteroid use in the context of the uncertainties surrounding the prediction of spontaneous preterm birth, and the need for health care professionals to provide the necessary information and support to women during the course of their treatment. Q Where considered safe, tocolytic therapy should be considered as an intervention to gain time to complete a single course of antenatal corticosteroids. There are separate WHO recommendations relating to use of tocolytic therapy for women with a high likelihood of preterm birth prior to 34 weeks’ gestation (34). Q The GDG reaffirms that all pre-conditions outlined for antenatal corticosteroid therapy in Recommendation 1.0 apply.

Implementation considerations outlined in Table 2.