Use of antenatal fluorinated corticosteroids in management of congenital heart block: Systematic review and meta-analysis

Objective: To evaluate outcomes of fluorinated corticosteroids, with or without other medications, for treatment of congenital heart block in-utero.

Study design: A search was conducted through MEDLINE, EMBASE, WEB OF SCIENCE and SCOPUS from inception to October 2017. Only comparative studies are considered eligible. Outcomes include fetal death, downgrade of heart block, neonatal death, need for neonatal pacing, fetal and maternal complications. Random effects model was used.

Results: Out of 923 articles, 12 studies were eligible. Compared to no treatment, there was no significant difference in incidence of fetal death (OR 1.10, 95%CI 0.65-1.84), neonatal death (OR 0.98, 95%CI 0.41-2.33), or need for pacing (OR 1.46, 95%CI 0.78-2.74). Heart block downgrade was significantly higher in treatment group (9.48%vs.1.76%, OR 3.27, 95%CI 1.23-8.71).

Conclusion: antenatal fluorinated corticosteroids do not improve fetal/neonatal morbidity or mortality of congenital heart block and are associated with higher incidence of fetal and maternal complications.