Projected benefits of universal or scheduled antepartum corticosteroids to prevent neonatal morbidity: A decision analysis

Objective The purpose of this study was to compare strategies of corticosteroid administration for the prevention of neonatal morbidity and death. Study design A Markov decision model compared 3 strategies of antepartum corticosteroid administration: (1) to all pregnant women (universal), (2) to all pregnant women with a previous preterm delivery (high risk), and (3) to women who had preterm labor symptoms that placed them at risk for delivery within 7 days (current). A second model with addition of a “rescue” arm to capture women who remained undelivered was also created. Results Compared with the current strategy, the universal strategy would result in roughly 1000 fewer cases of respiratory distress syndrome and >3 million more women would receive corticosteroids annually. The addition of a rescue arm further reduces morbidity and mortality rates. Conclusion A universal strategy of corticosteroid administration confers potential benefit for the prevention neonatal morbidity or death over the current strategy but requires that a large number of women be treated.