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Am J Perinatol 2024; 41(S 01): e594-e600
DOI: 10.1055/a-1925-1435
Original Article

Obstacles to Optimal Antenatal Corticosteroid Administration to Eligible Patients

Kara M. Rood
1   Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
,
Lynda G. Ugwu
2   The George Washington University Biostatistics Center, Washington, District of Columbia
,
William A. Grobman
3   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Jennifer L. Bailit
4   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
,
Ronald J. Wapner
5   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Michael W. Varner 
6   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
John M. Thorp Jr.
7   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Steve N. Caritis
8   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Alan T. N. Tita
9   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
George R. Saade
10   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Dwight J. Rouse
11   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Sean C. Blackwell
12   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas
,
Jorge E. Tolosa
13   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network › Author Affiliations Funding The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; grant nos.: HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, and HD53118) and the National Center for Research Resources (grant nos.: UL1 RR024989 and 5UL1 RR025764). Comments and views of the authors do not necessarily represent views of the National Institutes of Health.
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Abstract

Objective Administration of antenatal corticosteroids (ANCS) is recommended for individuals expected to deliver between 24 and 34 weeks of gestation. Properly timed administration of ANCS achieves maximal benefit. However, more than 50% of individuals receive ANCS outside the recommended window. This study aimed to examine maternal and hospital factors associated with suboptimal receipt of ANCS among individuals who deliver between 24 and 34 weeks of gestation.

Study Design Secondary analysis of the Assessment of Perinatal Excellence (APEX), an observational study of births to 115,502 individuals at 25 hospitals in the United States from March 2008 to February 2011, was conducted. Data from 3,123 individuals who gave birth to a nonanomalous live-born infant between 240/7 to 340/7 weeks of gestation, had prenatal records available at delivery, and data available on the timing of ANCS use were included in this analysis. Eligible individuals' ANCS status was categorized as optimal (full course completed >24 hours after ANCS but not >7 days before birth) or suboptimal (none, too late, or too early). Maternal and hospital-level variables were compared using optimal as the referent group. Hierarchical multinomial logistic regression models, with site as a random effect, were used to identify maternal and hospital-level characteristics associated with optimal ANCS use.

Results Overall, 83.6% (2,612/3,123) of eligible individuals received any treatment: 1,216 (38.9%) optimal and 1,907 (61.1%) suboptimal. Within suboptimal group, 495 (15.9%) received ANCS too late, 901 (28.9%) too early, and 511 (16.4%) did not receive any ANCS. Optimal ANCS varied depending on indication for hospital admission (p < 0.001). Individuals who were admitted with intent to deliver were less likely to receive optimal ANCS while individuals admitted for hypertensive diseases of pregnancy were most likely to receive optimal ANCS (10 vs. 35%). The median gestational age of individuals who received optimal ANCS was 31.0 weeks. Adjusting for hospital factors, hospitals with electronic medical records and who receive transfers have fewer eligible individuals who did not receive ANCS. ANCS administration and timing varied substantially by hospital, optimal frequencies ranged from 9.1 to 51.3%, and none frequencies from 6.1 to 61.8%. When evaluating variation by hospital site, models with maternal and hospital factors did not explain any of the variation in ANCS use.

Conclusion Optimal ANCS use varied by maternal and hospital factors and by hospital site, indicating opportunities for improvement.

Key Points

  • Majority of individuals who deliver between 24 and 34 weeks of gestation do not receive properly timed antenatal corticosteroids.

  • Optimal use of antenatal corticosteroids varies by maternal and hospital factors and hospital site.

  • Significant variation in hospital sites regarding optimally timed administration of antenatal corticosteroids indicates opportunities for improvement.

Keywords

antenatal corticosteroids - preterm birth - preterm delivery

Note

Abstract was presented at 2016 Society for Maternal Fetal Medicine 36th Annual Pregnancy Meeting Atlanta, GA.


Supplementary Material



Publication History

Received: 06 April 2022

Accepted: 05 August 2022

Accepted Manuscript online:
16 August 2022

Article published online:
01 October 2022

© 2022. Thieme. All rights reserved.

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