Abstract
BackgroundAntenatal corticosteroid treatment is globally recommended for women at risk of giving birth before 34 weeks of gestation. In Japan, data on the rate of completing recommended antenatal corticosteroid treatment are lacking. This study aimed to: (i) determine the proportion of patients treated for threatened preterm birth with tocolysis who received antenatal glucocorticoids; and (ii) analyze the association between long-term tocolysis and antenatal glucocorticoids treatment as recommended.MethodsThis was a retrospective cohort study using a national inpatient database in Japan. We selected pregnant women who had undergone treatment in hospitals due to threatened preterm birth and received the tocolytic ritodrine hydrochloride by infusion from July 2010 to March 2016, and delivered at < 34 weeks of gestation. The primary outcome was receiving of antenatal glucocorticoid treatment as recommended. Multivariable logistic regression was performed to evaluate factors associated with receiving antenatal glucocorticoid treatment.ResultsOnly 23% of 4048 eligible patients received glucocorticoid treatment as recommended. Those with longer durations of ritodrine hydrochloride infusion were significantly less likely to receive glucocorticoid treatment as recommended.ConclusionsIn Japan, many patients who receive tocolytic treatment for threatened preterm birth do not receive antenatal glucocorticoid treatment as recommended. Recommended treatment based on apparent evidences should be performed for the patients with threatened preterm birth.
Highlights
Antenatal corticosteroid treatment is globally recommended for women at risk of giving birth before 34 weeks of gestation
The prophylactic corticosteroids reduce the incidence of Shigemi and Yasunaga BMC Pregnancy and Childbirth (2019) 19:17 respiratory distress syndrome and, ideally, the glucocorticoid treatment in the recommended dosage should be completed within the 7 days before preterm birth [8]
We investigated the proportion of patients who received antenatal glucocorticoid as recommended, which was defined as administration of the recommended dosage of maternal glucocorticoids within 7 days before preterm birth (< 34 weeks of gestation) during hospitalization
Summary
Antenatal corticosteroid treatment is globally recommended for women at risk of giving birth before 34 weeks of gestation. Extended tocolytic treatment for preterm labour is reportedly ineffective, whereas delay of delivery for 48 h in women with threatened labour before 34 weeks allows recommended antenatal corticosteroid treatment, which improves fetal maturity and enables transfer of the pregnant woman to a centre with a neonatal intensive care unit [4,5,6,7]. This guideline stated that a single repeat course of antenatal corticosteroids should be considered in women who are at less than 34 weeks of gestation, at risk of preterm delivery within the 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously [11]. World Health Organization guidelines recommend administration of magnesium sulfate to women at risk of imminent birth before 32 weeks of gestation to prevent cerebral palsy [8]
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