REMARKS Q The GDG noted that there is no evidence on the comparative efficacy of dexamethasone and betamethasone that would support a recommendation of one over the other. The GDG acknowledged that dexamethasone has an advantage over betamethasone in terms of lower cost and wider availability, and it is currently listed for use in pregnant women on the WHO Essential Medicine List. Q The GDG acknowledged that the doses and regimens for both dexamethasone and betamethasone varied slightly across trials comparing the two, but noted that in the majority a total steroid dose of 24 mg was administered in divided doses 12 hours or 24 hours apart. Four doses of IM dexamethasone 6 mg 12 hours apart or 2 doses of IM betamethasone 12 mg 24 hours apart were the preferred choice in most of the studies. Q When deciding on the dosing frequency, consideration should be given to the likely timing of preterm birth to ensure that the woman completes the total course of antenatal corticosteroids or receives a substantial amount of the total dose before birth. Although there were no data on women’s satisfaction, women are likely to prefer fewer injections. Q The GDG reviewed the important differences in the type and preparation of antenatal corticosteroids across settings and emphasized that local protocols on the type and dosing regimen should be informed by the preparations that are readily available in their setting. This will not only encourage uptake and ease their use by health care professionals but also avoid incorrect dosing and wastage of resources. Q The GDG acknowledged that there are ongoing antenatal corticosteroid studies using different doses, regimens, and routes of administration and welcome these as research priorities.

Implementation considerations outlined in Table 2.