Maximizing Benefit From Antenatal Steroid Use While Avoiding Overuse.

Area of Science:

• Obstetrics and Gynecology
• Neonatal Perinatal Medicine
• Clinical Pharmacology

Background:

• Antenatal corticosteroids (ACS) are crucial for fetal lung maturation.
• Optimal timing of ACS administration is critical for maximizing benefits and minimizing risks.
• Current real-world data on ACS timing and associated factors are limited.

Purpose of the Study:

• To analyze real-world data on antenatal corticosteroid timing in relation to delivery.
• To identify patient factors and diagnoses associated with optimal ACS timing.
• To inform benchmarking goals and practical strategies for ACS administration.

Main Methods:

• Retrospective cohort study of singleton deliveries (2016-2024) at two academic hospitals.
• Primary cohort: deliveries between 24 0/7 and 33 6/7 weeks gestation.
• Analysis of ACS timing (none, optimal, suboptimal) and multivariable logistic regression.

Main Results:

• 56.7% of deliveries before 34 weeks had optimally timed ACS.
• Factors associated with optimal timing included hypertensive disorders, preterm labor, and PPROM.
• Certain conditions like anxiety disorder and placenta previa were associated with suboptimal timing.

Conclusions:

• Achieving optimal antenatal corticosteroid timing is a significant clinical challenge.
• Improved prediction of preterm delivery and individualized assessments are necessary.
• Timely ACS access for high-risk pregnancies requires enhanced strategies to reduce unnecessary exposure.