Antenatal corticosteroid treatment for women with hypertensive disorders of pregnancy: A population-based study in Japan

Aim

This study aimed to evaluate the current antenatal corticosteroid (ACS) treatment practices for hypertensive disorders of pregnancy (HDP) in Japan, by evaluating annual trends and identifying clinical disparities and factors influencing non-administration of ACS.

Methods

This retrospective population-based study was conducted using the Japanese Perinatal Research Network Database from 2013 to 2022. We analyzed ACS administration rates over time, across facility types, and the timing of delivery. Factors influencing non-administration were identified using univariate and multivariate logistic regression analyses.

Results

ACS administration rates among patients with HDP nearly doubled over the past decade, reaching 64.0% in 2022. Approximately 70% of patients with HDP who received ACS delivered before 34 weeks of gestation; however, only 30% achieved the optimal administration-to-birth interval of 48 h to 7 days. ACS administration rates in patients with HDP differed by facility type: 67.8% (1641/2419) in general perinatal medical centers, 60.5% (1107/1830) in regional perinatal medical centers, and 39.7% (23/58) in non-perinatal medical centers. Factors contributing to non-administration included smoking during pregnancy, eclampsia, placental abruption, HELLP syndrome, regional perinatal medical centers, non-perinatal medical centers, and gestational hypertension. Conversely, conditions such as fetal growth restriction, threatened preterm labor, and preterm premature rupture of membranes were associated with higher rates of ACS administration.

Conclusions

Although ACS administration rates in patients with HDP have improved over time, challenges remain in achieving optimal administration timing and addressing facility-based disparities. To improve administration rates, clinicians should increase awareness of ACS treatment and proactively manage HDP-related emergencies.