Antenatal corticosteroid prophylaxis at late preterm gestation: Clinical
guidelines vs clinical practice
Abstract
Objective: To investigate whether the Antenatal Late Preterm Steroids
(ALPS) trial, has been translated into clinical practice in Canada and
the United States. Temporal trends in optimal and suboptimal antenatal
corticosteroid (ACS) use among late preterm deliveries were also
assessed. Design: A retrospective cohort study. Setting: USA and Canada,
2007 to 2020. Population: All live births in the US (n= 32,476,039) and
Nova Scotia, Canada (n= 116,575). Methods and Main outcome measured:
Using data from the Natality database and the Nova Scotia Atlee
Perinatal Database, ACS administration within specific categories of
gestational age was assessed by calculating rates per 100 live births.
Temporal trends in optimal, and suboptimal ACS use were also assessed.
Results: In Nova Scotia, the rate of any ACS administration increased
significantly among women delivering at 35-36 weeks, from 15.2% in
2007-2016 to 19.6% in 2017-2020 (OR 1.36, 95%CI 1.14, 1.62). In the
U.S., among live births at 35-36 weeks’ gestation, any ACS use increased
from 4.1% in 2007–2016 to 18.5% in 2017–2020 (OR 5.33, 95% CI
5.28–5.38). Among infants between 24 and 34 weeks’ gestation in Nova
Scotia, 32% received optimally timed ACS, while 47% received ACS with
suboptimal timing. Of the women who received ACS in 2020, 34% in Canada
and 20% in the United States delivered at ≥37 weeks. Conclusion:
Publication of the ALPS trial resulted in increased ACS administration
at late preterm gestation in Nova Scotia, Canada and the U.S.. However,
a significant fraction of women receiving ACS prophylaxis delivered at
term gestation.