Antenatal corticosteroid administration among infants born at 22 weeks gestation after a practice advisory endorsing its consideration.

Abstract

Background: In response to an accumulation of evidence supporting antenatal steroid administration at 22 weeks gestation with planned neonatal resuscitation, the American College of Obstetricians and Gynecologists (ACOG), alongside the Society for Maternal Fetal Medicine, published a clinical practice advisory recommending consideration of antenatal steroids at 22 weeks gestation in September of 2021.

Objective: To determine if the 2021 ACOG Practice Advisory was associated with an increase in the use of antenatal corticosteroids among infants born at 22 weeks gestation.

Study design: Our retrospective, secondary analysis used data from the US Centers for Disease Control and Prevention's National Vital Statistics System from 2017-2023. The primary outcome was antenatal steroid use as recorded on the birth certificate, and our main exposure was the birth year which was dichotomized as after practice guideline implementation (2022-2023) vs before (2017-2020). Chi-squared and rank-sum tests were used, respectively, to compare gestational age before vs after guideline implementation. A multivariable regression using a difference-in-difference specification model was used to determine antenatal steroid use among 22-, and 24-25-week births, and a separate multivariable model was included using live births at 23 weeks as a sensitivity analysis.

Results: After applying our exclusion criteria, a total of 11,203 live births in the United States at 22-25 weeks gestation between 2017-2020 and 2022-2023 were available for analysis. Our bivariate analysis indicated an increased use of antenatal steroids in live births at 22 weeks gestation from 48% (178/368) before, to 61% (216/356) after the ACOG guideline implementation (p = 0.001). However, steroid administration did not change at 23 weeks (p = 0.385) with only a slight increase from 63% to 66% at 24-25 weeks (p = 0.033) in our bivariate analysis. Our multivariable analysis found similar patterns with 65% higher odds of steroid use in births at 22 weeks (p = 0.001) with no significant change at 24-25 weeks birth (p = 0.061). Similar results were found in our sensitivity analysis at 22-week births (p = 0.001), but no significant association was identified at 23 weeks (p = 0.710).

Conclusion: The recommendation by ACOG to consider antenatal corticosteroid administration in preterm deliveries at 22 weeks gestation has led to an increase in this clinical practice. This significant association highlights the value and influence of clinical practice guidelines among clinicians.