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Trends in antenatal corticosteroid administration: did our timing improve?
Paul Rostin1, Stefan Verlohren1, Wolfgang Henrich1
1Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
Insights
Effective antenatal corticosteroid prophylaxis (ACS) administration rates increased over time, reducing late preterm births. However, ineffective ACS remains a concern in specific conditions like placenta previa and twin pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Antenatal corticosteroids (ACS) are crucial for preterm birth management.
- Optimizing ACS timing is essential to maximize fetal lung maturation benefits.
- Understanding trends in ACS effectiveness is vital for improving perinatal outcomes.
Purpose of the Study:
- To analyze trends in effective antenatal corticosteroid prophylaxis (ACS) administration.
- To evaluate the rate of effective ACS in relation to preterm birth diagnoses.
- To identify conditions associated with ineffective ACS timing.
Main Methods:
- Retrospective analysis of delivery data (2014-2020) at Charité Berlin.
- Defined effective ACS as administration within 10 days of delivery.
- Analyzed ACS effectiveness trends in overall cohort and specific diagnoses (placental dysfunction, cervical insufficiency).
Main Results:
- Overall effective ACS rate was 42%.
- Deliveries at/after 37 weeks post-ACS decreased to 19%.
- Ineffective ACS was noted in placenta previa, twin pregnancy, and isthmocervical insufficiency (19-34% effective).
- ACS effectiveness significantly increased over the study period (p=0.002), particularly in placental dysfunction and cervical insufficiency.
Conclusions:
- A decrease in post-ACS deliveries at/after 37 weeks was observed compared to previous data.
- Ineffective ACS remains prevalent in specific obstetric conditions.
- Further research is needed to determine if novel diagnostic tools enhance ACS effectiveness.
Objectives:
We aimed to analyze trends in the rate of effective antenatal corticosteroid prophylaxis (ACS) administrations across a spectrum of typical diagnoses associated with preterm birth.
Methods:
In this retrospective study we utilized delivery data after ACS from 2014 to 2020 at Charité Berlin, Germany. We evaluated the rate of effective ACS administrations defined as ≤10 days between last dose of ACS and delivery as well as the rate of post-ACS births on/after 37 + 0 weeks. We explored conditions associated with high rates of ineffective ACS administrations (>10 days before delivery). We analyzed the trend of ACS-effectiveness during the study period in the overall cohort and in placental dysfunction and cervical insufficiency diagnoses.
Results:
The overall rate of effective ACS administrations was 42 % (709/1,672). The overall percentage of deliveries after/at 37 + 0 weeks following ACS administration was 19 % (343). Placenta previa, twin pregnancy and isthmocervical insufficiency were associated with ineffective ACS (19-34 % effective i.e. ≤10 days before delivery). The overall ratio of effective ACS applications rose over time (p=0.002). Over the course of this study ACS effectiveness increased in placental dysfunction and isthmocervical insufficiency diagnoses (p=0.028; p=0.001).
Conclusions:
Compared to a previous publication we found a decrease of post-ACS deliveries after/at 37 + 0 weeks (19 vs. 27 %). Ineffective ACS administrations are still frequent in patients with placenta previa, twin pregnancy and isthmocervical insufficiency. It remains to be investigated in future trials if the introduction of new diagnostic tools such as soluble Fms-like tyrosinkinase-1/placental growth factor (sFlt-1/PlGF) testing and placental alpha-microglobulin-1 (PAMG-1) testing directly led to an increased ACS effectiveness.
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