Hospital-Level Variation in Antenatal Corticosteroids for Late Preterm Births

The study examined differences among 728 American hospitals in the use of corticosteroids for late preterm births (34-36 weeks of gestation) during 2015-2022. The analysis included 5,452,791 deliveries, of which 361,006 (6.6%) were late preterm births. Steroid exposure varied substantially between hospitals, ranging from 0% to 82%. Hospitals were divided into four groups based on steroid usage rates, with median exposure increasing from 14.1% in hospitals with lowest adoption to 47.6% in hospitals with highest adoption. Urban hospital location and a higher proportion of deliveries at 34 weeks of gestation were associated with higher steroid adoption. Southern hospitals had lower odds of high adoption compared to Midwest hospitals. The results indicate heterogeneous adoption of recommendations following publication of the ALPS trial.