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

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.