(272) Appropriate Timing of Steroid Administration in Pregnancies At Risk for Preterm Delivery

The objective of this study was to evaluate the timing of steroid administration in both the preterm and late preterm pregnancies and to evaluate the impact of timing on adverse neonatal outcomes.

Study Design:

This was a retrospective chart review of all pregnant individuals who delivered at a single academic hospital between 1/1/2016 to 12/31/2016. Non-anomalous, singleton gestations who received antenatal steroids and had available delivery information were included. Maternal demographics, indications for steroid administration, delivery information, and neonatal outcomes were all collected. Latency from steroids to delivery was calculated and analyzed as >7 days or ≤7 days and >14 days or ≤14 days. Statistical analysis with descriptive statistics and logistic regression was done.

Results:

Of 1986 deliveries at our institution, 211 (10.6%) met inclusion criteria. A total of 87 (41.2%) delivered >7 days from early steroid administration with the most common indications for steroids being hypertension, preterm prelabor rupture of membranes, and preterm labor. Of those >7 days and >14 days from steroids, 29 (50.9%) and 23 (62.2%) received a rescue course, respectively. In the late preterm period, 35 (92.1%) delivered ≤7 days. An interval of >7 days from steroids was not associated with composite adverse perinatal outcomes as compared to those ≤7 days (OR 1.34, CI 0.58-3.12). Regression analyses showed that greater delivery gestational age was associated with less adverse neonatal outcomes in both the early (OR 0.83, CI 0.79-0.89) and late preterm period (OR 0.79, CI 0.66-0.95). When evaluating for delivery predictors, a regression showed that maternal race (OR 0.31, CI 0.12-0.83), prior preterm birth (OR 0.45, CI 0.22-0.95), and cervical dilation (OR 1.65, CI 1.2-2.2) had an impact on steroid timing >7 days from delivery.

Conclusion:

Our results were consistent with prior literature indicating that objective criteria need to be developed for optimally timed steroids within seven days of delivery.