Use, misuse, and overuse of antenatal corticosteroids. A retrospective cohort study

Liviu Cojocaru; Shruti Chakravarthy; Hooman Tadbiri; Rishika Reddy; James Ducey; Gary Fruhman

doi:10.1515/jpm-2023-0074

Article

Use, misuse, and overuse of antenatal corticosteroids. A retrospective cohort study

Liviu Cojocaru , Shruti Chakravarthy , Hooman Tadbiri , Rishika Reddy , James Ducey and Gary Fruhman

Published/Copyright: May 22, 2023

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From the journal Journal of Perinatal Medicine Volume 51 Issue 8

Abstract

Objectives

To evaluate the timing of antenatal corticosteroids (ACS) administration in relation to the delivery timing based on indications and risk factors for preterm delivery.

Methods

We conducted a retrospective cohort study to understand what factors predict the optimal timing of ACS administration (ACS administration within seven days). We reviewed consecutive charts of adult pregnant women receiving ACS from January 1, 2011, to December 31, 2019. We excluded pregnancies under 23 weeks, incomplete and duplicate records, and patients delivered outside our health system. The timing of ACS administration was categorized as optimal or suboptimal. These groups were analyzed regarding demographics, indications for ACS administration, risk factors for preterm delivery, and signs and symptoms of preterm labor.

Results

We identified 25,776 deliveries. ACS were administered to 531 pregnancies, of which 478 met the inclusion criteria. Of the 478 pregnancies included in the study, 266 (55.6 %) were delivered in the optimal timeframe. There was a higher proportion of patients receiving ACS for the indication of threatened preterm labor in the suboptimal group as compared to the optimal group (85.4 % vs. 63.5 %, p<0.001). In addition, patients who delivered in the suboptimal timeframe had a higher proportion of short cervix (33 % vs. 6.4 %, p<0.001) and positive fetal fibronectin (19.8 % vs. 1.1 %, p<0.001) compared to those who delivered in the optimal timeframe.

Conclusions

More emphasis should be placed on the judicious use of ACS. Emphasis should be placed on clinical assessment rather than relying solely on imaging and laboratory tests. Re-appraisal of institutional practices and thoughtful ACS administration based on the risk-benefit ratio is warranted.

Keywords: antenatal diagnosis; corticosteroids; premature birth; prematurity; preterm labor

Corresponding author: Liviu Cojocaru, MD, Department of Obstetrics, Gynecology, Division of Maternal-Fetal Medicine, Staten Island University Hospital of Northwell Health, New York, NY, USA; Current address: Department of Anesthesiology, Perioperative Care, and Pain Medicine, Division of Anesthesia Critical Care, New York University Grossman School of Medicine, New York, NY, USA; and Sponsor: Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA, E-mail: cliviu@me.com

Current address: Shruti Chakravarthy, Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Peoria, IL, USA. Current address: Rishika Reddy, Department of Obstetrics and Gynecology, Northside Hospital Gwinnett, Lawrenceville, GA, USA.

Research funding: None declared.
Author contributions: LC and SC drafted the manuscript. HT performed the statistical analysis and ensured its correct interpretation. All authors contributed to the final version’s writing and editing. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interest: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The Institutional Review Board at Staten Island University Hospital approved the study under protocols #18–0157 and #20–0361, respectively.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpm-2023-0074).

Received: 2023-02-20

Accepted: 2023-04-19

Published Online: 2023-05-22

Published in Print: 2023-10-26

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Keywords for this article

antenatal diagnosis; corticosteroids; premature birth; prematurity; preterm labor