Association between antenatal corticosteroid use and perinatal mortality among preterm births in hospitals in Tanzania

Abstract

Objectives The primary aims of this study were to investigate if exposure to antenatal corticosteroids (ACS) was associated with lower rates of perinatal mortality (primary outcome) and other adverse perinatal outcomes (i.e., stillbirth, early neonatal mortality, APGAR score of < 7 at 5 mins, neonatal sepsis and respiratory distress syndrome) in preterm infants in hospitals in Tanzania. We also examine factors associated with administration of ACS among women at risk of preterm delivery. Methods A hospital-based prospective chart review study was undertaken in four hospitals located in Nyamagana and Sengerema districts, Tanzania. The study population included all stillborn and live born preterm infants delivered between 24 to 34 weeks of gestation between July 2019 to February 2020. A total 1125 preterm infants were delivered by 1008 women (895 singletons, 230 multiple). Sociodemographic and medical data were recorded from participants’ medical records. Results Three hundred and fifty-six (35.3%) women were administered at least one dose of ACS between 24 to 34 weeks’ gestation and 385 (34.2%) infants were exposed to ACS. Infants exposed to ACS had a lower rate of perinatal mortality (13.77%) compared to those who were not exposed (28.38%). Multivariate analysis indicated that infants exposed to ACS were less likely to die during perinatal period, aRR 0.34 (95%CI 0.26-0.44). Only one-third of the sample was provided with ACS. Administration of ACS was associated with maternal education, attending antenatal care more than 3 times, method used to assess gestational age, maternal infection, exposure to maternal antibiotics, delivery mode and level of health facility. Conclusion ACS significantly reduced the risk in perinatal mortality among infants born preterm in a limited resource setting. However, only about one-third of eligible women were provided with ACS, indicating low usage of ACS. Numerous factors were associated with low usage of ACS in this setting.

Association between antenatal corticosteroids use and perinatal mortality among preterm singletons and twins in Mwanza, Tanzania: an observational study

“…Despite the benefits of ACS in reducing the risk of adverse perinatal outcomes, particularly in singletons, in the present study, less than 40% of the mothers of singletons were administered at least one dose of ACS. The main reason given by health professionals in these low-resource settings for not administrating ACS was that women arrived late at the hospital in well-established labour 15. Another potential impediment to administering ACS in low-resource settings could be difficulty in obtaining an accurate estimate of gestational age.…”

“…This is a secondary analysis of data from an observational prospective chart review study that investigated if exposure to ACS was associated with lower rates of perinatal mortality in preterm infants 15. It was conducted in four selected hospitals located in Nyamagana and Sengerema districts, which are two of the seven districts of the Mwanza region, northwest Tanzania.…”

“…To address the primary research aim of the initial study, based on a power of 95%, an estimated minimum overall sample size of 1010 (both twins and singletons) was determined using Open-Source Epidemiologic Statistics for Public Health (Open Epi) 15 17…”

“…Specifically, the model was fitted with generalised estimating equations to account for the associations within a pair of twins from the same mother. Multivariate analyses were performed to examine the effects of ACS on perinatal mortality and RDS controlling for the following factors, gestational age, birth weight, level of health facility and mode of delivery 15. P values of less than 0.05 were considered statistically significant.…”

“…This is a secondary analysis of data from an observational prospective chart review study that investigated if exposure to ACS was associated with lower rates of perinatal mortality in preterm infants. 15 It was conducted in four selected hospitals located in Nyamagana and Sengerema districts, which are two of the seven districts of the Mwanza region, northwest Tanzania. The hospitals that participated were Bugando Medical Centre (a tertiary consultant zonal referral hospital), Sekou Toure Regional Referral Hospital, Nyamagana District Hospital and Sengerema District Designated Hospital.…”