Colm P Travers clinical fellow, Reese H Clark vice president and co-director, Alan R Spitzer senior vice president and director, Abhik Das senior research statistician, Thomas J Garite professor, Waldemar A Carlo professor et al
Travers Colm P, Clark Reese H, Spitzer Alan R, Das Abhik, Garite Thomas J, Carlo Waldemar A et al.
Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study
BMJ 2017; 356 :j1039
Why did it take so long for antenatal steroid use to become mainstream
It was in 1972 that Sir Graham Collingwood Liggins and Ross Howie published the results of their double blinded randomised controlled study demonstrating that Antepartum Glucocorticoid Treatment had a preventative effect of Premature infants developing Respiratory distress syndrome ¹
Having been involved in UK based Obstetric Practice for the last quarter of a century, we have witnessed first-hand the powerful benefits of antenatal corticosteroids have on premature infants. And had ringside seats observing how very slow the uptake in use of antenatal corticosteroids was. In 1995, steroid use was occasional, and it was only by 2000 did it appear that antenatal steroid use for the benefit of premature infants had become mainstream.
And one might ask why this was so. There are very few, if any other drugs, that have taken 25 years to become main stream from initial inception. And certainly, none that carry such a powerfully beneficial effect as antenatal corticosteroids. One may argue that clinicians had reservations on trying out new drugs on pregnant women for fear of hitherto undetected teratogenic effects. And to some extent, that is true – Just look at the old fashioned and poorly effective labetalol we treat hypertensive pregnant women with. But the most compelling explanation is there was no patent on the drug, and so no one stood to profit from its introduction. There is little doubt that had a major pharmaceutical firm could profit from the introduction of antepartum glucocorticoid treatment to be given to pregnant women threatening to have premature labour, the uptake would have been a lot more rapid.
In certain circles, it is fashionable to deride big pharma. As a counter to that it is worthwhile remembering that in this scenario, the pharmaceutical industry is highly likely to have got the administration of antenatal glucocorticoids rolled out far more promptly that it has taken without the benefit of the pharmaceutical industry. Saving myriads of premature infants from preventable death
References
1 Liggins, Graham Collingwood, and Ross Howie. “A Controlled Trial of Antepartum Glucocorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants.” Pediatrics 50 (1972): 515–25.
Competing interests: No competing interests