Antenatal corticosteroids for early preterm birth: implementation strategy lessons from the WHO ACTION-I trial

Ayesha De Costa, Olufemi T. Oladapo, Shuchita Gupta, Anayda Portela, Joshua P. Vogel, Joao Paulo Souza, Suman Rao, Nicole Minckas, Özge Tuncalp, Rajiv Bahl, Fernando Althabe

Research output: Contribution to journalArticleOtherpeer-review

1 Citation (Scopus)


The WHO ACTION-I trial, the largest placebo-controlled trial on antenatal corticosteroids (ACS) efficacy and safety to date, reaffirmed the benefits of ACS on mortality reduction among early preterm newborns in low-income settings. We discuss here lessons learned from ACTION-I trial that are relevant to a strategy for ACS implementation to optimize impact. Key elements included (i) gestational age dating by ultrasound (ii) application of appropriate selection criteria by trained obstetric physicians to identify women with a likelihood of preterm birth for ACS administration; and (iii) provision of a minimum package of care for preterm newborns in facilities. This strategy accurately identified a large proportion of women who eventually gave birth preterm, and resulted in a 16% reduction in neonatal mortality from ACS use. Policy-makers, programme managers and clinicians are encouraged to consider this implementation strategy to effectively scale and harness the benefits of ACS in saving preterm newborn lives.

Original languageEnglish
Article number141
Number of pages6
JournalHealth Research Policy and Systems
Issue number1
Publication statusPublished - 28 Dec 2022
Externally publishedYes


  • Antenatal corticosteroids
  • Neonatal mortality
  • Preterm birth

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