Optimising timing of steroid administration in preterm pre-eclampsia.

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Maternal-Fetal Medicine

Background:

• Antenatal corticosteroids (ACS) improve preterm birth outcomes but optimal timing is critical.
• Suboptimal timing, including intervals >7 days or repeated courses, may be associated with harm.
• Pre-eclampsia is a major cause of iatrogenic preterm birth, necessitating delivery for maternal and fetal well-being.

Purpose of the Study:

• To investigate the optimal use and timing of antenatal corticosteroids (ACS) in women with preterm pre-eclampsia delivering before 35 weeks' gestation.
• To evaluate the impact of ACS timing on neonatal outcomes and delivery modes in this high-risk population.

Main Methods:

• Retrospective analysis of 250 women with preterm pre-eclampsia delivering <35 weeks' gestation in the UK.
• Categorization of ACS administration into optimal timing (>24h to <7 days), late timing (>7 days), or no administration.
• Comparison of neonatal outcomes (gestational age, birthweight, respiratory distress, mortality) and delivery methods (vaginal vs. C-section) across groups.

Main Results:

• Only 31% of women received optimally timed ACS; 49% received it >7 days pre-delivery.
• No significant differences in key neonatal outcomes (gestational age, birthweight, RDS, mortality) were observed between ACS timing groups.
• Non-receipt of ACS was associated with higher intrauterine fetal death rates and increased rates of vaginal delivery with reduced C-sections.

Conclusions:

• Optimal antenatal corticosteroid administration is infrequent in women with preterm pre-eclampsia.
• Clinicians should consider deferring ACS until delivery is imminent, prioritizing administration once the decision to deliver is made.
• Judicious use of ACS, particularly in the context of pre-eclampsia, may optimize maternal-fetal outcomes and delivery management.