Factors Related to Corticosteroid Utilization in Preterm Birth

We sought to determine the rate of corticosteroid administration in preterm births in our institution and to describe factors associated with lack of corticosteroid exposure. We performed a retrospective case-control analysis. Of the 312 eligible women who delivered between 24 and 34 weeks' gestation, maternal corticosteroid administration was documented in 262 (84%) and no exposure in 50 (16%). A shorter admission to delivery interval (< 48 hours) decreased the likelihood of corticosteroid administration (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.03 to 0.28, p < 0.001). Use of tocolytics was associated with a lower risk of corticosteroid nonexposure (OR 0.21, 95% CI 0.04 to 0.69, p = 0.006). Lack of prenatal care was associated with an increased risk of corticosteroid nonexposure (OR 3.18, 95% CI 1.01 to 9.15, p = 0.01). The likelihood of corticosteroid administration was also decreased by gestational ages at the upper limit of the spectrum (33 to 34 weeks; OR 0.22, 95% CI 0.09 to 0.53, p < 0.001). The latter effect persisted after exclusion of premature rupture of membranes cases. In our population, factors associated with no maternal corticosteroid administration were shorter interval between admission and delivery, gestational age at the upper limit of the currently recommended interval for corticosteroid administration, and lack of prenatal care.