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Facility-Level Factors Associating Antenatal Corticosteroid Administration Rates and Subsequent Term Birth Rates: A
Kazuya Fuma1, Takafumi Ushida1,2, Takahiro Imaizumi3
1Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Aim:
The antenatal corticosteroid (ACS) administration rate in Japan is low. To achieve both high coverage and low overtreatment of ACS, understanding of facility-level factors is important. This study aimed to identify facility-level factors associated with ACS coverage and overtreatment and simulate the potential consequences of increased ACS use.
Methods:
This observational study used data from the 2020 to 2022 Perinatal Registry Database maintained by the Japan Society of Obstetrics and Gynecology. Primary outcomes were: (1) ACS administration rate among preterm births before 34 weeks (ACS/34w rate) and (2) proportion of term births among ACS recipients (term/ACS proportion). Multivariable regression analyses examined associations with facility-level factors including perinatal care level, location, delivery volume, and prevalence of maternal conditions. A simulation estimated the impact of increasing ACS/34w rate to 80% in facilities with lower baseline rates.
Results:
In the facility-level analysis of 244 facilities (376 717 records), the mean ACS/34w rate was 63.4%, and term/ACS proportion was 12.0%. The proportion of threatened preterm labor (coefficient: 4.4 [95% confidence interval: 2.1-6.7]), deliveries < 34 weeks (3.0 [0.1-5.8]), and cesarean section rate (-2.4 [-4.5 to -0.2]) were significantly associated with ACS/34w rate. ACS/34w rate (2.0 [0.8-3.3]), annual delivery volume (2.1 [0.6-3.5]), and cesarean section rate (1.5 [0.2-2.7]) were positively associated with term/ACS proportion, while perinatal care level was inversely associated (-3.5 [-6.3 to -0.6]). Simulation estimated 2311 additional ACS recipients and 465 term births per year.
Conclusions:
Facility-level factors influence ACS coverage and overtreatment. These findings may inform strategies for optimizing ACS use.
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