In a large U.S. study, most patients who gave birth at 34 weeks of pregnancy or earlier received steroid medicine before delivery, yet only about half received it during the short window when it works best, researchers reported.
Corticosteroids, anti-inflammatory medicines used in various diseases, may be given before birth when there is a risk of preterm delivery to help speed up the baby’s lung development. In fetal and neonatal alloimmune thrombocytopenia, corticosteroids are prescribed to suppress the maternal immune system and prevent it from attacking the baby’s platelets, the cells that help blood clot.
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Among births before 34 weeks of pregnancy, when babies benefit most from these steroids, the mother received at least one dose in about 83% of cases, but only about 55% got it within the optimal seven-day window. That timing rate stayed flat across the five years studied.
The research, published in the journal Pregnancy, looked at a database of births from 2017 to 2021 and included a total of 105,981 births from 12 U.S. hospitals. The authors set out to measure how often, and how well-timed, antenatal corticosteroids were given, since they work best when administered within seven days before delivery, a window that is hard to hit because the timing of a preterm birth is difficult to predict.
Steroid use rose, however, among pregnancies ending between 34 and nearly 37 weeks, climbing from about 37% to 47% over the period. The share of treated patients who ultimately carried to full term also increased, from roughly 16% to 22%, meaning more pregnancies received steroids without an early birth following.
Some situations made well-timed treatment more likely than others. Preeclampsia, a serious blood-pressure condition of pregnancy, was associated with better timing. Ruptured membranes (when the fluid-filled sac surrounding the baby breaks before labor) and placenta previa (when the placenta covers the cervix) were each associated with poorer timing.
As the use of steroids rises in late preterm and term births, the researchers noted the need for long-term follow-up of children exposed to steroids later in pregnancy. Such studies, they wrote, “will be key to appropriately reflect on current practices and guidelines.”
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