Society for Maternal-Fetal Medicine Special Statement: Quality metrics for optimal timing of antenatal corticosteroid administration

• Published in: American journal of obstetrics and gynecology 2022-06, Vol.226 (6), p.B2-B10
• Main Authors: Hamm, Rebecca Feldman, Combs, C. Andrew, Aghajanian, Paola, Friedman, Alexander M.
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Benchmarking; betamethasone; dexamethasone; Female; Humans; Infant, Newborn; Infant, Premature; perinatal death; perinatal morbidity; Perinatology; Pregnancy; Premature Birth - prevention & control; preterm birth; quality improvement
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2022.02.021

Preterm birth is a leading cause of perinatal morbidity and mortality. Antenatal corticosteroid administration before preterm birth reduces the risks of perinatal death, respiratory morbidity, necrotizing enterocolitis, and intraventricular hemorrhage and reduces the costs of perinatal care. Antenatal corticosteroids are optimally effective when administered within 7 days before preterm birth. However, only 20% to 40% of early preterm infants receive antenatal corticosteroids within 7 days before birth, in part because it is difficult to predict the precise timing of preterm birth. Until 2020, The Joint Commission had a Perinatal Care quality metric measuring the rate of antenatal corticosteroid administration at any time before early preterm birth. This metric incentivized providers to use antenatal corticosteroids liberally. The Joint Commission retired the metric in 2020 after the rate reached more than 97% in The Joint Commission–accredited hospitals. However, the metric did not evaluate whether the timing of antenatal corticosteroid administration was optimal, that is, within 7 days of birth. A 2016 multistakeholder Cooperative Workshop recommended the development of a new quality metric to assess the rate of optimally timed antenatal corticosteroids among early preterm births. In this statement, we outline proposed specifications for such a metric and discuss potential uses, advantages, limitations, and barriers. Furthermore, we propose a balancing metric that tracks the percentage of patients treated with antenatal corticosteroids who ultimately give birth at term. We suggest that the use of these new metrics may incentivize more conservative antenatal corticosteroid timing, which could, in turn, lead to meaningfully improved outcomes for preterm neonates.