We have several comments regarding the letters about our study.1 First, Gerard Visser and Gian Carlo DiRenzo state that if corticosteroids are given appropriately they can reduce perinatal morbidity and mortality, whereas inappropriate use is likely to be harmful. However, the evidence showing that corticosteroids reduce neonatal morbidity and mortality are from studies done in hospitals in high-income and middle-income countries with good newborn care. By contrast, our antenatal corticosteroid trial (ACT)1 was done in low-income and middle-income countries, evidence showed no benefit with use of this drug.
