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Trends in optimal, suboptimal, and questionably appropriate receipt of antenatal corticosteroid prophylaxis

Neda Razaz1, Amanda Skoll, John Fahey

  • 1Department of Obstetrics & Gynaecology and the School of Population and Public Health, University of British Columbia, and the BC Women's Hospital and Health Centre, Vancouver, British Columbia, and the Reproductive Care Program of Nova Scotia and the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada.

Obstetrics and Gynecology
|January 9, 2015
PubMed

Insights

Antenatal corticosteroid use increased, but optimal administration did not keep pace with suboptimal and questionable use. Accurate preterm birth prediction models are needed to improve timing of these crucial treatments.

Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Medicine
  • Clinical Pharmacology

Background:

  • Antenatal corticosteroids (ACS) are crucial for fetal lung maturation.
  • Optimal timing of ACS is essential for maximizing benefits and minimizing risks.

Purpose of the Study:

  • To assess temporal trends in optimal, suboptimal, and questionably appropriate ACS administration.
  • To evaluate ACS use in relation to gestational age at birth.

Main Methods:

  • Population-based study of live births in Nova Scotia, Canada (1988-2012).
  • Quantified temporal trends using odds ratios and 95% confidence intervals.
  • Defined optimal, suboptimal, and questionably appropriate ACS exposure based on timing and gestational age.

Main Results:

  • ACS exposure increased significantly for neonates born between 28-34 weeks gestation.
  • Optimal ACS receipt rose from 10% to 23%, but suboptimal and questionably appropriate use also increased substantially.
  • In 2012, 52% of women receiving ACS delivered at 35 weeks gestation or greater.

Conclusions:

  • Increases in optimal ACS use were paralleled by rises in suboptimal and questionably appropriate administration.
  • There is a critical need for improved preterm delivery prognostic models to optimize ACS timing.
Abstract

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