In 2015, the World Health Organization (WHO) recommended that antenatal glucocorticoids should be used only under certain conditions, including the accurate assessment of gestational age, imminent preterm birth, the absence of maternal infection, and adequate care for childbirth and preterm newborns. The guideline panel and an expert panel that was subsequently convened by the WHO identified the conduct of efficacy trials in hospitals in low-resource countries as a research priority in order to resolve this controversy and guide clinicians and policymakers on the use of antenatal glucocorticoids. We conducted the WHO ACTION-I (Antenatal Corticosteroids for Improving Outcomes in Preterm Newborns) trial, a randomized trial to assess the safety and efficacy of dexamethasone in women in hospitals in low-resource countries who were at risk for early preterm birth.

 The Action 1 trial found that among women in low-resource countries at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection.