Repeat prenatal corticosteroids: Who still recommends their use and why?

Abstract

Background: Repeat prenatal corticosteroids have been in common use worldwide, even though the National Institutes of Health recommends that ‘Until data establish a favourable benefit-to-risk ratio, repeat courses of antenatal corticosteroids, including rescue therapy, should be reserved for patients enrolled in clinical trials.’ Objectives: To describe the current use/recommendations for the use of repeat prenatal corticosteroids by obstetricians and neonatologists and to examine the sources of evidence on which their practice is based. Design: Postal questionnaire. Population: All Trainees, Members and Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and neonatologists in Australia and New Zealand. Methods: The questionnaire was mailed to obstetricians and neonatologists in August–September 2001. Main outcome measures: Practitioner use/recommendations for the use of repeat prenatal corticosteroids and the sources of evidence on which their practice was based. Results: Use of repeat prenatal corticosteroids was recommended by 332 (44%) obstetricians and 19 (21%) neonatologists. Obstetricians were twice as likely to recommend their use compared with neonatologists (relative risk, 2.04; 95% confidence intervals, 1.36–3.06; P < 0.001). Over half of the respondents (483, 57%) reported they had changed their use/recommendations in the previous 3 years. The sources of evidence behind these practices differed between obstetricians and neonatologists and between those practitioners who recommended the use of repeat prenatal corticosteroids and those who did not. Conclusions: Fewer practitioners recommend repeat prenatal corticosteroids compared with previous surveys. Sources of evidence behind the practice of groups of obstetricians and neonatologists differ.