Term Delivery After Late-Preterm Antenatal Steroid Administration in U.S. Hospitals

Given the challenges in accurately predicting birth timing, we sought to quantify the proportion of individuals who receive late-preterm steroids in routine clinical practice who ultimately deliver at term. This retrospective cohort study of singleton gestations used data from January 2021 to December 2024 from the Premier Healthcare Database. We calculated the proportion of late-preterm steroid exposures in women who delivered at term and analyzed rates by hospital. The cohort included 519 hospitals and 97,322 singleton delivery hospitalizations of women with late-preterm betamethasone exposure. Of these, 28.8% (28,021) delivered at term, which equated to 1.0% (28,021 of 2,800,799) of all singleton term births being exposed to late-preterm steroids. Adjusted hospital-level proportions of singleton term births in individuals exposed to late-preterm steroids ranged from 0% to 63% with a median of 29%, reflecting substantial heterogeneity in late-preterm steroid use. This study highlights the need to develop accurate prediction methods for preterm birth timing and policies to inform optimal late-preterm steroid use.