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Antenatal Corticosteroids: Factors Associated with Failure to Treat• 1305

Objective: Many infants are delivered prematurely without benefit of antenatal corticosteroids (AC) despite proven efficacy and publicized practice guidelines. We hypothesized that women who deliver premature infants without AC are more likely to have received routine rather than high risk prenatal care, and to have lower socioeconomic status (SES) and minority race status. Methods: A retrospective medical record review of 506 women who delivered liveborn infants at 20 to 34 weeks gestational age (GA) between July 1,1995 and June 30,1996 in a perinatal referral center was performed. All mothers were included who met ACOG criteria for AC. SES was measured by maternal age, educational level, hourly wage, and employment. Admitting services were classified as community private, academic private, and academic teaching. Transfer from routine care in the referral region to high risk care in the perinatal center was documented. Clinical features included presence of cervical dilation and ruptured amniotic membranes, birthweight, and GA of the infant. Receipt of AC was classified as none, at least one dose, or a full course in compliance with ACOG guidelines. Data were analyzed with chi square, Cramer's V, Kruskal-Wallis ANOVA, and general linear modeling (GLM). Results: Overall, 33% of eligible women were not treated with AC, while 30% received at least one dose and 37% received a full course. SES, race and rupture of membranes were not associated with receipt of AC. Failure to treat was associated with admission to a private community or private academic attending rather than the teaching service (V=.15,p<.0001), prenatal care in the immediate rather than outlying geographic region (V=.23,p<.0001), cervical dilatation (V=.25,p<.0001), and greater GA on admission(r=.14,p<.0001). GLM was used to examine the relationship of significant variables with AC treatment status. GA, referral/transfer status and hospital admission service are all associated (p<.01). Mothers admitted to private community obstetricians were less likely to receive AC than those admitted to the academic private or teaching services. Of those who did not receive AC, GA was lower for mothers admitted to community private attendings (28 weeks) than for those admitted to private academic attendings (32 weeks) or the teaching service (31 weeks)(p<.019).