Antenatal corticosteroid administration among infants born at 22 weeks' gestation after a practice advisory endorsing...

In response to an accumulation of evidence supporting antenatal steroid administration at 22 weeks of gestation with planned neonatal resuscitation, the American College of Obstetricians and Gynecologists, alongside the Society for Maternal-Fetal Medicine, published a clinical practice advisory recommending consideration of antenatal steroids at 22 weeks of gestation in September 2021.

This study aimed to determine whether the 2021 American College of Obstetricians and Gynecologists practice advisory was associated with an increase in the use of antenatal corticosteroids among infants born at 22 weeks of gestation.

This retrospective, secondary analysis used data from the United States Centers for Disease Control and Prevention's National Vital Statistics System from 2017 to 2023. The primary outcome was antenatal steroid use as recorded on the birth certificate, and our main exposure was the birth year that was dichotomized as after (2022-2023) vs before (2017-2020) practice guideline implementation. The chi-square and rank-sum tests were used to compare gestational age before and after the implementation of the guideline, respectively. A multivariate regression using a difference-in-difference specification model was used to determine antenatal steroid use among births at 22 and 24 to 25 weeks of gestation, and a separate multivariate model was included using live births at 23 weeks of gestation for sensitivity analysis.

After applying our exclusion criteria, a total of 11,203 live births in the United States at 22 to 25 weeks of gestation between 2017-2020 and 2022-2023 were available for analysis. Our bivariate analysis indicated an increased use of antenatal steroids in live births at 22 weeks of gestation from 48% (178/368) before to 61% (216/356) after the American College of Obstetricians and Gynecologists guideline implementation (P=.001). However, steroid administration did not change at 23 weeks of gestation (P=.385), with only a slight increase from 63% to 66% at 24 to 25 weeks of gestation (P=.033) in our bivariate analysis. Our multivariate analysis found similar patterns, with 65% higher odds of steroid use in births at 22 weeks of gestation (P=.001), with no significant change in births at 24 to 25 weeks of gestation (P=.061). Similar results were found in our sensitivity analysis of births at 22 weeks of gestation (P=.001), but no significant association was identified for births at 23 weeks of gestation (P=.710).

The recommendation by the American College of Obstetricians and Gynecologists to consider antenatal corticosteroid administration in preterm deliveries at 22 weeks of gestation has led to an increase in this clinical practice. This significant association highlights the value and influence of clinical practice guidelines among clinicians.