Why Adoption Rates of Late Preterm Steroids Vary Widely
The clinical utilization of late preterm steroids remains a topic of significant debate in obstetric care. Clinicians frequently prescribe betamethasone between 34 and 36 weeks of gestation to reduce neonatal respiratory complications. However, actual clinical adoption varies considerably across healthcare institutions. A recent investigation evaluated practice patterns across hundreds of healthcare facilities to assess this disparity.
Hospital Adoption of Late Preterm Steroids
Researchers conducted a nationwide cohort study examining delivery records between 2015 and 2022. Specifically, the analysis included 726 hospitals and more than five million total births. Among these deliveries, singleton late preterm births accounted for 309,837 cases. The authors observed dramatic differences in institutional exposure rates, ranging from 0% to 92%. Consequently, the investigators divided hospitals into four performance quartiles. The lowest-adopting quartile demonstrated a median exposure rate of only 15.4%. In contrast, the highest-adopting institutions achieved a median exposure rate of 54.3%. Furthermore, substantial practice variations persisted even within the same quartiles.
Key Predictors and Geographic Disparities
Multivariable regression models identified distinct hospital characteristics that influenced betamethasone administration. For instance, urban hospital status strongly predicted placement in the highest adoption quartile. Urban centers had more than double the adjusted odds of high adoption compared to rural counterparts. Additionally, geographic location significantly affected prescribing patterns across the country. Hospitals in the Southern region displayed substantially lower odds of high adoption than Midwestern facilities. Therefore, non-clinical factors like geography and hospital infrastructure appear to drive clinical treatment decisions.
Clinical Implications for Obstetric Practice
Late preterm delivery constitutes a significant proportion of neonatal intensive care admissions globally. Hence, standardized protocols are necessary to ensure equitable and evidence-based steroid administration. Obstetricians must carefully balance respiratory benefits against potential neonatal risks, such as hypoglycemia. Moreover, clinicians often struggle to predict the exact timing of delivery within seven days. As a result, many pregnant individuals receive betamethasone but deliver at full term. Thus, health systems should establish clear clinical pathways to optimize treatment timing and avoid unnecessary exposures.
Frequently Asked Questions
Q1: What are late preterm steroids?
They are antenatal corticosteroid injections, typically betamethasone, administered between 34 and 36 weeks of gestation to accelerate fetal lung maturation.
Q2: Why does institutional adoption of these steroids vary so widely?
Institutional variation stems from differences in hospital protocols, urban versus rural infrastructure, provider familiarity with trials, and regional prescribing cultures.
Q3: What are the main clinical risks of late preterm steroid administration?
While steroids reduce neonatal respiratory distress, they significantly increase the incidence of neonatal hypoglycemia and may cause potential long-term neurodevelopmental concerns.
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References
- Clapp MA et al. Hospital-Level Variation in Antenatal Corticosteroid Use for Late Preterm Births. Obstet Gynecol. 2026 Nov 10. doi: 10.1097/AOG.0000000000006467. PMID: 43008238.
- Society for Maternal-Fetal Medicine (SMFM). SMFM Consult Series #58: Use of antenatal corticosteroids for individuals at risk for late preterm delivery. Am J Obstet Gynecol. 2021;225(5):B2-B14.
- World Health Organization. WHO recommendations on antenatal corticosteroids for improving preterm birth outcomes. Geneva: World Health Organization; 2022.
