gms | German Medical Science

Background: Preterm birth (PTB) is also one of the most frequent pregnancy-related risks in Germany with an esti-mated prevalence of about 9% [1]. In pregnancy’s with a higher risk for PTB before 34 week of pregnancy, corticosteroids (ACS) are administered for fetal lung maturity, which is intended to prevent an infant respiratory distress syndrome [2]. However, the effect of ACS can only be achieved if the application interval between administration and birth is at least 24 hours but not more than 7 days [3]. It suggests that the ideal time window is rarely reached [4], which is why the standard administration of corticosteroids with an increased risk of preterm birth before the 34th week due to the expected side effects in question [5].

Aim/Research Question: The aim of this paper was to investigate how often ACS were administered within the optimal timeframe in women under risk for PTB in relation to diagnosis (PPROM, placental bleeding, premature laboratory, preeclampsia, oligohydramnios, amniotic infection syndrome (AIS), cervical insufficiency) and risk factors (maternal age >35 years, prior preterm delivery, stillbirth or abortion, multiple pregnancy, gestational diabetes, hypertension and nicotine abuse). Specifically, it was intended to analyze in which patients the steroids could be administered within or outside the defined ideal timeframe and whether there were differences in relation to the ACS diagnosis and the risk factors. In addition, it was examined whether there are statistically significant differences between patients within and outside the ideal timeframe in terms of sociodemographic factors, diagnoses and risk factors, and whether the odds ratio (OR) for achieving the ideal timeframe increase in relation to existing diagnoses and risk factors. Finally, it should also be examined after how many days it came to birth after ACS administration in relation to diagnosis and risk factors.

Methods: The study was designed as a retrospective cohort trial, in which the data of all births taking place in the German federal state Rhineland-Palatinate (about 38,000 births per year) were evaluated for 2016. From these dataset, the data of all those mothers (n=1,544) were extracted who were hospitalized in 2016 due to a threatening premature birth and were provided with corticosteroid. In the statistical calculation, frequency analyses, subgroup analyses (Chi-square tests and Friedman tests) and logistic regression were performed.

Results: Only in about one quarter of all pregnant women who are treated with ACS because of an increased risk of PTB, a birth occurs within the ideal timeframe (≥24h and ≤7 days). The ideal timeframe after ACS administration was reached most common in patients with AIS (34.85%), preeclampsia (33.83%) as well as in presence of hypertension (32%) and in multiple diagnoses (40.14%). There was an OR >1 for a birth event within the ideal timeframe in patients with PPROM, AIS and preeclampsia, while there was no benefit in patients with cervix insufficiency.

Relevance: It can be stated that in women who have an increased risk of premature birth before the 34^th week of pregnancy, the individual risk profile should first be identified.

Recommendations/Conclusion: In women under risk for PTB, the individual risk profile should first be identified before ACS management starts.

Ethics and conflicts of interest: It was not necessary to obtain a vote on ethics. The research was financed by own resources. There are no conflicts of interest.