Prenatal Corticosteroids for Reducing Morbidity and mortality after Preterm Birth
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In 1959 the New Zealand obstetrician Graham (Mont) Liggins began investigating mechanisms that triggered premature labour. Supported by the Wellcome Trust, he examined the effects of hormones on labour in sheep, and demonstrated coincidentally that in utero corticosteroids accelerated fetal lung maturation. A randomized controlled trial (RCT) of prenatal corticosteroids in humans by Liggins and pediatrician Ross Howie, showed a reduction of respiratory distress syndrome in preterm babies. This Witness Seminar, chaired by the late Dr Edmund Hey, discussed the influence of Liggins' and Howie's 1972 paper announcing these results, and subsequent work by Avery and Kotas on induction of pulmonary surfactant in lambs. Other subjects included Crowley's 1981 systematic review of four RCTs; the low uptake of corticosteroids in practice until the Royal College of Obstetricians and Gynaecologists issued usage guidelines in 1992; trials to determine optimum drug, dose and number of courses; potential adverse effects; and cost-benefit analysis. Participants included the late Dr Mel Avery, Sir Iain Chalmers, Dr Patricia Crowley, the late Professor Harold Gamsu, Professor Jane Harding, Professor Richard Lilford, Professor Miranda Mugford, Professor Ann Oakley, Professor Dafydd Walters and Mr John Williams. Appendices from Liggins and Howie; Liggins' Wellcome Trust grant; and the protocol of the 1975 UK trial of betamethasone, complete the volume. Reynolds L A, Tansey E M. (eds) (2005) Prenatal corticosteroids for reducing morbidity and mortality after preterm birth, Wellcome Witnesses to Twentieth Century Medicine, volume 25. London: The Wellcome Trust Centre for the History of Medicine at UCL.