The Impact of the Antenatal Late Preterm Steroids Trial on the administration of Antenatal Corticosteroids

Elise Kearsey, Jasper V. Been, Vivienne Souter, Sarah J E Stock

Research output: Contribution to journalArticlepeer-review

Abstract

Background
In 2016 the Antenatal Late Preterm Steroids study was published, demonstrating that antenatal corticosteroid therapy (ACT) given to women at risk of late preterm delivery reduces respiratory morbidity in infants. However, the administration of ACT in late preterm infants remains controversial.
Late preterm infants do not suffer from the same rate of morbidity as early preterm infants, and the short-term benefits of ACT are less pronounced, consequently the risk of possible harm is more difficult to balance.

Objective
This study aimed to evaluate the association between the publication of the Antenatal Late Preterm Steroids study or the subsequent changes in guidelines and the rates of antenatal corticosteroid therapy administration in late preterm infants in the United States.

Study Design
Data analysed was publicly available USA birth certificate data from 1st January 2016 to 31st December 2018. An interrupted time series design was used to analyse the association between publication of the ALPS study and changes in monthly rates of antenatal corticosteroid administration in late preterm gestation (34+0 to 36+6 weeks). Births 28+0 to 31+6 weeks’ gestation were used as a control. ACT administration in births 32+0 to 34+6 weeks was explored to analyse whether the intervention influenced ACT administration in women in the subgroup approaching 34 weeks’ gestation. ACT administration in term births (>37 weeks’ gestation), was analysed to explore if the intervention influenced the number of term babies exposed to ACT. Our regression model allowed for both step and slope changes to be analysed. The intervention period was chosen as February 2016.

Results
Our sample size was 18,031,950 total births, of these, 1,056,047 were births at 34+0 weeks to 36+6 weeks’ gestation, 123,788 were births at 28+0 weeks to 31+6 weeks’ gestation, 153,708 were births at 32 weeks to 33 weeks’ gestation and 16,602,699 were term births. 95,708 were births <28 weeks’ gestation. There was a statistically significant increase in antenatal corticosteroid therapy rates in late preterm births following online publication of the Antenatal Late Preterm Steroids study (adjusted Incidence Rate Ratio: 1.48; 95% CI: 1.36-1.61, P-value = 0.00). A significant increase in ACT rates was also seen in full-term births following online publication of the Antenatal Late Preterm Steroids study. No significant changes were seen in antenatal corticosteroid rates in gestational age groups 32+0 to 33+6 weeks or 28+0 to 31+6 weeks.

Conclusion
Online publication of the Antenatal Late Preterm Steroids study was associated with an immediate and sustained increase in the rates of antenatal corticosteroid therapy in late preterm birth across the USA. Demonstrating a swift and successful implementation of the Antenatal Late Preterm Steroids study guidance into clinical practise. However, there is an increase in full-term infants receiving ACT unnecessarily and as the long-term consequences of ACT are yet to be elucidated effort should be made to minimise the number of infants unnecessarily exposed to ACT.
Original languageEnglish
JournalAmerican Journal of Obstetrics and Gynecology
Early online date24 Mar 2022
DOIs
Publication statusE-pub ahead of print - 24 Mar 2022

Keywords

  • Preterm Birth
  • Steroids
  • Prematurity
  • Time series analysis
  • antenatal corticosteroids

Fingerprint

Dive into the research topics of 'The Impact of the Antenatal Late Preterm Steroids Trial on the administration of Antenatal Corticosteroids'. Together they form a unique fingerprint.

Cite this