Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health

dc.contributor.authorVogel, Joshua P.
dc.contributor.authorSouza, Joao Paulo
dc.contributor.authorGuelmezoglu, A. Metin
dc.contributor.authorMori, Rintaro
dc.contributor.authorLumbiganon, Pisake
dc.contributor.authorQureshi, Zahida
dc.contributor.authorCarroli, Guillermo
dc.contributor.authorLaopaiboon, Malinee
dc.contributor.authorFawole, Bukola
dc.contributor.authorGanchimeg, Togoobaatar
dc.contributor.authorZhang, Jun
dc.contributor.authorTorloni, Maria Regina [UNIFESP]
dc.contributor.authorBohren, Meghan
dc.contributor.authorTemmerman, Marleen
dc.contributor.authorWHO Multicountry Survey Maternal
dc.contributor.institutionUniv Western Australia
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.contributor.institutionNatl Ctr Child Hlth & Dev
dc.contributor.institutionKhon Kaen Univ
dc.contributor.institutionUniv Nairobi
dc.contributor.institutionCtr Rosarino Estudios Perinatales
dc.contributor.institutionUniv Ibadan
dc.contributor.institutionShanghai Jiao Tong Univ
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionBrazilian Cochrane Ctr
dc.contributor.institutionJohns Hopkins Bloomberg Sch Publ Hlth
dc.description.abstractBackground Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries.Methods WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. for this analysis, we included deliveries after 22 weeks' gestation and we excluded births that occurred outside a facility or quicker than 3 h after arrival. We calculated use of antenatal corticosteroids in women who gave birth between 26 and 34 weeks' gestation, when antenatal corticosteroids are known to be most beneficial. We also calculated use in women at 22-25 weeks' and 34-36 weeks' gestation. We assessed tocolytic drug use, with and without antenatal corticosteroids, in spontaneous, uncomplicated preterm deliveries at 26-34 weeks' gestation.Findings of 303 842 recorded deliveries after 22 weeks' gestation, 17 705 (6%) were preterm. 3900 (52%) of 7547 women who gave birth at 26-34 weeks' gestation, 94 (19%) of 497 women who gave birth at 22-25 weeks' gestation, and 2276 (24%) of 9661 women who gave birth at 35-36 weeks' gestation received antenatal corticosteroids. Rates of antenatal corticosteroid use varied between countries (median 54%, range 16-91%; IQR 30-68%). of 4677 women who were potentially eligible for tocolysis drugs, 1276 (27%) were treated with bed rest or hydration and 2248 (48%) received no treatment. beta-agonists alone (n=346, 7%) were the most frequently used tocolytic drug. Only 848 (18%) of potentially eligible women received both a tocolytic drug and antenatal corticosteroids.Interpretation Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice.en
dc.description.affiliationUniv Western Australia, Fac Med Dent & Hlth Sci, Sch Populat Hlth, Crawley, WA, Australia
dc.description.affiliationWHO, Dept Reprod Hlth & Res, UNDP UNFPA UNICEF WHO World Bank Special Programm, CH-1211 Geneva, Switzerland
dc.description.affiliationUniv São Paulo, Ribeirao Preto Med Sch, Dept Social Med, BR-14049 Ribeirao Preto, Brazil
dc.description.affiliationNatl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, Japan
dc.description.affiliationKhon Kaen Univ, Fac Med, Dept Obstet & Gynecol, Khon Kaen, Thailand
dc.description.affiliationKhon Kaen Univ, Fac Publ Hlth, Dept Biostat & Demog, Khon Kaen, Thailand
dc.description.affiliationUniv Nairobi, Coll Hlth Sci, Sch Med, Dept Obstet & Gynaecol, Nairobi, Kenya
dc.description.affiliationCtr Rosarino Estudios Perinatales, Rosario, Argentina
dc.description.affiliationUniv Ibadan, Ibadan, Nigeria
dc.description.affiliationShanghai Jiao Tong Univ, Sch Med, Xinhua Hosp, Shanghai 200030, Peoples R China
dc.description.affiliationUniversidade Federal de São Paulo, Dept Obstet, São Paulo, Brazil
dc.description.affiliationBrazilian Cochrane Ctr, São Paulo, Brazil
dc.description.affiliationJohns Hopkins Bloomberg Sch Publ Hlth, Dept Populat Family & Reprod Hlth, Baltimore, MD USA
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Dept Obstet, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)
dc.description.sponsorshipMinistry of Health, Labour and Welfare of Japan
dc.description.sponsorshipGynuity Health Projects
dc.identifier.citationLancet. New York: Elsevier B.V., v. 384, n. 9957, p. 1869-1877, 2014.
dc.publisherElsevier B.V.
dc.rightsAcesso restrito
dc.titleUse of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Healthen