458 - Inequities in Antenatal Corticosteroid Use in the United States in 2023: State, Medicaid Enrollment, and Racial/Ethnic Patterns for Births at 24-36 Weeks

Publication Number: 458.5254

Laura L. Jelliffe-Pawlowski, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Elizabeth E. Rogers, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Rebecca J.. Baer, UCSF, San Francisco, CA, United States; Scott P. Oltman, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Akila Subramaniam, University of Alabama School of Medicine, Birmingham, AL, United States; Safyer McKenzie-Sampson, Stanford University School of Medicine, Palo Alto, CA, United States; Dawn Gano, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Dana Gossett, New York University Grossman School of Medicine, New York, NY, United States; Justin Brandt, NYU Langone Health, New York, NY, United States; Louie M. Swander, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Laura Jelliffe-Pawlowski, New York Univeristy, New York, NY, United States; Kelli K. Ryckman, Indiana University, Bloomington, IN, United States

Background: For over a decade, a single course of antenatal corticosteroids (ACS) has been recommended for pregnant people at risk of preterm birth from 24 and 33.6 weeks of gestation to reduce infant morbidity and mortality. More recently, this recommendation was expanded to include those at risk of delivery between 34 and 36.6 weeks.

Objective: We sought to describe patterns of ACS administration in pregnancies delivering at 24 to 36 completed weeks across the US in 2023.

Design/Methods: Analysis included 366,094 births at 24-36 weeks gestation, where ACS administration data was recorded in natality records maintained by the CDC’s National Center for Health Statistics. We examined ACS use percentages at 24-34 and 35-36 weeks (reported as whole numbers) across all states and the District of Columbia (DC), including variations across counties (overall and by mean (95% CI)). Comparisons were made between Medicaid and non-Medicaid-insured groups (as a proxy for socioeconomic stats) using odds ratios (ORs) and 95% CIs. Within-state ACS patterns were further analyzed by racial/ethnicity group (categorized as Hispanic and non-Hispanic: American Indian/Alaska Native, Asian, Black, Hawaiian/Pacific Islander, White, and two or more races) with pairwise comparisons for all groups with 10 or more reported births by chi-square test.

Results: ACS rates at 24-34 weeks varied significantly, from 15.2% (95% CI 12.3-18.2%) in Hawaii to 73.3% (71.4-75.1%) in Wisconsin (Figure 1). Percent ACS use at 35-36 versus 24-34 weeks was substantially lower across all states and DC but still showed wide variation (from 3.9% (2.6-5.2%) in Hawaii to 38.4% (34.4-42.4%) in Alaska). County-level ACS use showed substantial within-state variation; for instance, in the five most populous states, ACS rates at 24-34 weeks ranged widely by county: California (12.7-73.0%), Texas (5.8-75.0%), Florida (0.0-67.0%), New York (8.1-50.3%), and Pennsylvania (30.6-70.0%) (Figure 2). Non-Medicaid-insured pregnancies were often more likely to receive ACS; in DC for example, 50.4% of non-Medicaid pregnancies at 24-34 weeks received ACS versus 34.5% in those with Medicaid (OR 1.92, 95% CI 1.3-3.0) (Figure 3). Racial/ethnic inequities were evident, most commonly between non-Hispanic Black and White groups.

Conclusion(s): Inequities in ACS use are present across states and counties and vary by socioeconomic and racial/ethnic groups. Understanding ACS usage patterns offers a pathway for addressing these inequities, especially as ACS recommendations expand to other gestational age groups.

Figure 1. Percent (with 95% CI) of pregnancies delivering at 24 to 34 weeks with administration of antenatal corticosteroids (ACS) reported on vital statistics records by state (including the District of Columbia) in 2023.


Figure 2. Percent of pregnancies delivering at 24 to 34 weeks with antenatal corticosteroid (ACS) use by county and state (including the District of Columbia) (range and mean with 95% confidence interval).


Figure 3. Odds of antenatal corticosteroid (ACS) use in those without compared to with Medicaid insurance with deliveries at 24-34 weeks in 2023 in the US by state (including the District of Columbia).