Use, Misuse and Overuse of Antenatal Corticosteroids [39K

Abstract

INTRODUCTION: Antenatal corticosteroids (ACS) are a mainstay in the management of women at risk for preterm delivery, however previous studies raised concerns for long-term consequences including increased risk of metabolic disease and neuro-developmental effects. The purpose of this study was to review our hospital’s use of ACS in view of these possible risks. METHODS: After Institutional Review Board approval, a retrospective chart review from January 2011 through December 2017 was performed. Pregnancies in which ACS were administered in anticipation of preterm delivery were included. Those who delivered elsewhere or had incomplete charts were excluded. Data collection and descriptive analysis were performed with Research Electronic Data Capture. RESULTS: ACS were administered in 432 pregnancies, of which 391 met inclusion criteria. Of these, 77.5% delivered preterm. However, 42.5% of all 391 pregnancies delivered at or above 34 weeks. Only 51.7% of all pregnancies delivered in the first seven days of administration of ACS, falling to only 35% when excluding those who delivered within 24 hours of the first dose. The most common indication for ACS administration was threatened preterm labor (70.1%). Of these, 43.8% delivered in the first seven days, falling to 24.5% when excluding those delivering in the first 24 hours. CONCLUSION: While three-quarters of women receiving ACS delivered preterm, a large proportion delivered at 34 weeks or greater and not within the optimal time frame of one to seven days. Further studies are needed to evaluate our administration of ACS, and particularly our assessment of preterm labor, to avoid unnecessary exposure and potential consequences.