Society for Maternal-Fetal Medicine Special Statement: Quality metrics for optimal timing of antenatal corticosteroid administration

Hamm, Rebecca F.; Combs, C. Andrew; Aghajanian, Paola; Friedman, Alexander M.

doi:10.1016/j.ajog.2022.02.021

Cited by 13 publications

(18 citation statements)

References 54 publications

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“…In the absence of future randomized controlled trials, which admittedly would be difficult but arguably not impossible, future studies should also include quality metrics evaluating the optimal timing of steroid administration. 21 Furthermore, additional research is needed to evaluate the increased prevalence of infectious morbidity with periviable corticosteroids observed in some studies and potential for harm in unstudied special populations such as those with pregestational diabetes. Large, diverse population-based studies, such as those performed by the NICHD Neonatal Research Network, 22 will continue to be instrumental in evaluating these uncommon outcomes.…”

Section: Discussionmentioning

confidence: 99%

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Battarbee

2023

Obstetrics &Amp; Gynecology

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Neonates born at the cusp of viability are at particularly high risk of severe morbidity and mortality. With advances in medicine and technology, the ability to resuscitate smaller, more premature neonates has become possible, and survival as early as 21 weeks of gestation has been reported. Although administration of antenatal corticosteroids has been shown to reduce the risk of morbidity and mortality at later gestational ages, neonates born before 24 weeks of gestation have not been included in randomized clinical trials. Changing clinical practices surrounding neonatal resuscitation with intervention offered after birth at earlier gestational ages has prompted re-evaluation of the use of antenatal corticosteroids at these very early gestational ages. Recent observational data demonstrate that antenatal corticosteroids administered before deliveries at or after 22 weeks of gestation are associated with lower risks of neonatal mortality, although survival with severe morbidity remains high. Future research is needed to determine the efficacy of antenatal corticosteroids for deliveries before 22 weeks of gestation and should evaluate the timing of corticosteroid administration. Furthermore, efforts should be made to include diverse populations and clinically meaningful long-term outcomes. At this time, the decision surrounding antenatal corticosteroids for threatened periviable deliveries should incorporate multidisciplinary counseling with the goal of achieving concordant prenatal and postnatal management aligned with the patient’s desires.

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Section: Discussionmentioning

confidence: 99%

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Battarbee

2023

Obstetrics &Amp; Gynecology

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“…27 The rate of antenatal steroid administration before early preterm births reached 97.8% in 2016 at the joint commission accredited hospitals. 28 Second, the detailed data regarding dating methods were not available.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Individuals who delivered in the U.S. between January 2014 and December 2020 (n=27,014,444) Individuals who delivered before 22 0/7 or after 28…”

mentioning

confidence: 99%

Infant Mortality Categorized by Birth Weight Percentiles for Deliveries Between 22 and 28 Weeks of Gestation

Onishi,

Bitas,

Kawakita

2024

Am J Perinatol

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Objective Our objective was to describe infant mortality within 1 year of life according to gestational age and birth weight percentile in infants delivered between 22 and 28 weeks of gestation. Study Design This study was a retrospective cohort study based on publicly available U.S. birth certificate data linked to infant death data between 2014 and 2020. Maternal–neonate pairs of singleton live births between 220/7 and 286/7 weeks' gestation (vaginal or cesarean) were evaluated. We excluded infants with major fetal anomalies, chromosomal disorders, and birth weight outliers. Our primary outcome was infant mortality within 1 year of life. Individuals were categorized into eight sex-specific birth weight percentiles categories: less than the 3rd, 3rd-less than the 10th, 10th-less than the 25th, 25th-to less than the 50th, 50th-less than the 75th, 75th-to less than the 90th, 90th-less than the 97th, and 97th or higher. Results Of 27,014,444 individuals with live births from January 2014 to December 2020, 151,677 individuals who gave birth at 22 to 28 weeks of gestation were included in the study population. The mortality rate ranged from 4.2% for the 50th-less than the 75th percentiles at 28 weeks to 80.3% for the 3rd-less than the 10th percentile at 22 weeks. Using the 50th-less than the 75th birth weight percentile at each gestational age as a reference group, birth weight less than the 50th percentile was associated with increased mortality at all gestational ages in a dose-dependent manner. From 22 to 25 weeks of gestation, higher birth weight percentiles were associated with lower mortality, while the 97th or higher birth weight percentile was associated with increased mortality compared with the 50th-less than the 75th birth weight percentile at 26 to 28 weeks of gestation. Conclusion The lower birth weight percentiles were associated with higher mortality across all gestational ages, but the association between higher birth weight percentiles and infant mortality exhibited an opposite pattern at 22 to 25 weeks as compared to later gestational age. Key Points

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“…6 ACS have optimal efficacy when given at least 24 h but less than 7 days prior to delivery. 7,8 However, timely administration is challenging and frequently suboptimal owing to the difficulty in predicting PTB. 9 PTB is associated with a multitude of risk factors, including previous PTB, infections, assisted reproductive techniques and other diverse maternal and fetal parameters, and its pathophysiology remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study

Danieli-Gruber

Levy

Gomez

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo examine suboptimal antenatal corticosteroid (ACS) administration based on indications and maternal‐obstetrical factors.MethodsWomen who prematurely delivered (24 + 0 to 36 + 6 gestational weeks) a viable neonate following ACS treatment between 2012 and 2019 were identified by a retrospective database review. The cohort was divided into patients in whom ACS administration was optimally timed (≥24 h to ≤7 days) or suboptimally timed (>7 days). The groups were compared for ACS indications and maternal, obstetrical, and neonatal parameters.ResultsThe cohort included 399 women. ACS timing was optimal in 233 patients (58%) and was associated with nulliparity (109 [46.8%] vs. 54 [32.5%], P = 0.004) and preterm premature rupture of membranes (89 [38.2%] vs. 45 [27.1%], P = 0.021). Suboptimal timing was associated with chronic hypertension (22 [9.4%] vs. 36 [21.7%], P < 0.001) and asymptomatic cervical shortening (23 [9.9%] vs. 26 [15.7%], P = 0.020). Optimal ACS timing was associated with higher neonatal intensive care unit admission (135 [58%] vs. 71 [42.8%], P = 0.003). On multivariate analysis, the adjusted odds ratio (aOR) of neonatal intensive care unit admission was 0.69 (95% confidence interval [CI], 0.58–0.83, P < 0.001) and 0.99 (95% CI, 0.99–1, P = 0.003) when adjusted for gestational age and birth weight, respectively. When adjusting for maternal age, the aOR for suboptimal ACS administraion due to chronic hypertension was 2.65 (95% CI, 1.49–4.72; P < 0.001).ConclusionOptimal timing of ACS varies based on different maternal characteristics and clinical indications. In the presence of certain parameters physicians tend to administer ACS suboptimally, diminishing its beneficial effect.

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Society for Maternal-Fetal Medicine Special Statement: Quality metrics for optimal timing of antenatal corticosteroid administration

Cited by 13 publications

References 54 publications

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Infant Mortality Categorized by Birth Weight Percentiles for Deliveries Between 22 and 28 Weeks of Gestation

Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study

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