Login Register Cart 0
Generic placeholder image

Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Challenges in Antenatal Corticosteroid Prescribing: A Retrospective Study

Author(s): Shannon Armstrong-Kempter*, Lucinda Beech, Sarah J. Melov, Adrienne Kirby and Roshini Nayyar

Volume 16, Issue 4, 2020

Page: [327 - 333] Pages: 7

DOI: 10.2174/1573404816999200430005045

Price: $65

Abstract

Background: The discovery of the benefits of antenatal corticosteroids (ACS) for preterm infants was one of the most significant developments in obstetric care. However, due to the difficulty in predicting preterm delivery, optimal use of ACS, is challenging.

Objective: To describe prescribing practices for antenatal corticosteroids (ACS) at a tertiary hospital over five years to determine whether ACS were received at optimal timing; to determine patient characteristics of women receiving ACS at optimal timing; to determine patient characteristics of those who did not receive ACS as indicated and to examine the trend in ACS prescribing over the study period.

Methods: We performed a retrospective study of all deliveries from January 2011 to December 2015. The rates of ACS prescription for each group of women (preterm, late preterm, and term) were recorded and analysed.

Results: A total of 65% of women who delivered before 34 weeks’ gestation received ACS. Of these women, 63% delivered within 7 days of receiving ACS. Women most likely to receive ACS with optimal timing were primiparous (relative risk [RR], 1.25 [CI, 1.08-1.45]), or women diagnosed with pre-eclampsia (RR, 1.34 [CI 1.10-1.63]), preterm premature rupture of membranes (RR, 1.33 [CI, 1.15-1.54]) or threatened preterm labour (RR, 1.42 [CI, 1.22-1.65]).

Conclusion: A significant number of women and babies are exposed to ACS without commensurate benefit, and a significant number who deliver preterm do not receive ACS. The percentage of preterm and term infants receiving ACS should be determined to optimise service delivery.

Keywords: Antenatal corticosteroids, corticosteroid prescribing, preterm birth, dexamethasone, betamethasone, neonatal prematurity, labor onset.

Graphical Abstract

[1]
Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3CD004454
[http://dx.doi.org/10.1002/14651858.CD004454.pub3] [PMID: 28321847]
[2]
Gyamfi-Bannerman C, Thom EA, Blackwell SC, et al. NICHD Maternal-Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 374(14): 1311-20.
[http://dx.doi.org/10.1056/NEJMoa1516783] [PMID: 26842679]
[3]
Jobe AH, Goldenberg RL. Antenatal corticosteroids: an assessment of anticipated benefits and potential risks. Am J Obstet Gynecol 2018; 219(1): 62-74.
[http://dx.doi.org/10.1016/j.ajog.2018.04.007] [PMID: 29630886]
[4]
WHO. World Health Organization recommendations on interventions to improve preterm birth outcomes Geneva Switzerland: Department of Maternal, Newborn, Child and Adolescent Health, 2015. Available from: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guideline/en/ [Accessed on: September 2018]
[5]
Newnham JP, Moss TJ, Nitsos I, Sloboda DM. Antenatal corticosteroids: the good, the bad and the unknown. Curr Opin Obstet Gynecol 2002; 14(6): 607-12.
[http://dx.doi.org/10.1097/00001703-200212000-00006] [PMID: 12441700]
[6]
Viteri OA, Blackwell SC, Chauhan SP, et al. Antenatal corticosteroids for the prevention of respiratory distress syndrome in premature twins. Obstet Gynecol 2016; 128(3): 583-91.
[http://dx.doi.org/10.1097/AOG.0000000000001577] [PMID: 27500336]
[7]
Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2013; (8): CD006764
[http://dx.doi.org/10.1002/14651858.CD006764.pub3] [PMID: 23990333]
[8]
Sotiriadis A, Tsiami A, Papatheodorou S, Baschat AA, Sarafidis K, Makrydimas G. Neurodevelopmental outcome after a single course of antenatal steroids in children born preterm: A Systematic Review and Meta-analysis. Obstet Gynecol 2015; 125(6): 1385-96.
[http://dx.doi.org/10.1097/AOG.0000000000000748] [PMID: 26000510]
[9]
Crowther CA, McKinlay CJ, Middleton P, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2011; (6): CD003935
[http://dx.doi.org/10.1002/14651858.CD003935.pub3] [PMID: 21678343]
[10]
[No authors listed]. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273: 413-8.
[11]
RCOG. RCOG Guidelines No.7: Antenatal corticosteroids to prevent respiratory distress syndrome. London, 2010. Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg7/ [Accessed on Feb 10, 2020]
[12]
Norman M, Piedvache A, Børch K, et al. Effective Perinatal Intensive Care in Europe (EPICE) Research Group. Association of short antenatal corticosteroid administration-to-birth intervals with survival and morbidity among very preterm infants: Results from the EPICE Cohort. JAMA Pediatr 2017; 171(7): 678-86.
[http://dx.doi.org/10.1001/jamapediatrics.2017.0602] [PMID: 28505223]
[13]
Wong D, Abdel-Latif M, Kent A. NICUS Network. Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study. Arch Dis Child Fetal Neonatal Ed 2014; 99(1): F12-20.
[http://dx.doi.org/10.1136/archdischild-2013-304705] [PMID: 24142624]
[14]
Polyakov A, Cohen S, Baum M, Trickey D, Jolley D, Wallace EM. Patterns of antenatal corticosteroid prescribing 1998-2004. Aust N Z J Obstet Gynaecol 2007; 47(1): 42-5.
[http://dx.doi.org/10.1111/j.1479-828X.2006.00677.x] [PMID: 17261099]
[15]
Laher A, Ballot DE, Ramdin T, Chirwa T. A review of antenatal corticosteroid use in premature neonates in a middle-income country. S Afr Med J 2017; 107(9): 768-72.
[http://dx.doi.org/10.7196/SAMJ.2017.v107i9.12246] [PMID: 28875885]
[16]
Smith JM, Gupta S, Williams E, et al. Providing antenatal corticosteroids for preterm birth: a quality improvement initiative in Cambodia and the Philippines. Int J Qual Health Care 2016; 28(6): 682-8.
[http://dx.doi.org/10.1093/intqhc/mzw095] [PMID: 27614015]
[17]
Vogel JP, Souza JP, Gülmezoglu AM, et al. WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health. Lancet 2014; 384(9957): 1869-77.
[http://dx.doi.org/10.1016/S0140-6736(14)60580-8] [PMID: 25128271]
[18]
Braun T, Sloboda DM, Tutschek B, et al. Fetal and neonatal outcomes after term and preterm delivery following betamethasone administration. Int J Gynaecol Obstet 2015; 130(1): 64-9.
[http://dx.doi.org/10.1016/j.ijgo.2015.01.013] [PMID: 25872453]
[19]
Jolley JA, Rajan PV, Petersen R, Fong A, Wing DA. Effect of antenatal betamethasone on blood glucose levels in women with and without diabetes. Diabetes Res Clin Pract 2016; 118: 98-104.
[http://dx.doi.org/10.1016/j.diabres.2016.06.005] [PMID: 27351800]
[20]
Murphy KE, Hannah ME, Willan AR, et al. MACS Collaborative Group. Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial. Lancet 2008; 372(9656): 2143-51.
[http://dx.doi.org/10.1016/S0140-6736(08)61929-7] [PMID: 19101390]
[21]
Dalziel SR, Walker NK, Parag V, et al. Cardiovascular risk factors after antenatal exposure to betamethasone: 30-year follow-up of a randomised controlled trial. Lancet 2005; 365(9474): 1856-62.
[http://dx.doi.org/10.1016/S0140-6736(05)66617-2] [PMID: 15924982]
[22]
Savoy C, Ferro MA, Schmidt LA, Saigal S, Van Lieshout RJ. Prenatal betamethasone exposure and psychopathology risk in extremely low birth weight survivors in the third and fourth decades of life. Psychoneuroendocrinology 2016; 74: 278-85.
[http://dx.doi.org/10.1016/j.psyneuen.2016.09.021] [PMID: 27693982]
[23]
Kamath-Rayne BD, Rozance PJ, Goldenberg RL, Jobe AH. Antenatal corticosteroids beyond 34 weeks gestation: What do we do now? Am J Obstet Gynecol 2016; 215(4): 423-30.
[http://dx.doi.org/10.1016/j.ajog.2016.06.023] [PMID: 27342043]
[24]
Dalziel SR, Lim VK, Lambert A, et al. Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomised controlled trial. BMJ 2005; 331(7518): 665.
[http://dx.doi.org/10.1136/bmj.38576.494363.E0] [PMID: 16143712]

Rights & Permissions Print Cite
Article Metrics
4
© 2024 Bentham Science Publishers | Privacy Policy