Sociodemographic Factors Associated with Antenatal Steroid Exposure among Late Preterm Births

As the risk of preterm birth is known to vary widely, we aimed to determine if antenatal steroid exposure among LPBs varied based on sociodemographic characteristics. We hypothesized that sociodemographic factors may influence a provider ‘s clinical judgment of a patient ‘s likelihood of preterm birth and, therefore, also be associated with antenatal steroid use. This cross-sectional analysis used the 2021 US natality data and included non-anomalous, liveborn, hospital-based singleton births at ≥34 weeks of gestation to mothers without diabetes, a cohort similar to those in the ALPS Trial. The following sociodemographic factors were compared among those who received vs. did not receive steroids using chi-square tests: age, race (as designated and categorized on the birth certificate), ethnicity, primary pay for the delivery, marital status, and education. In 2021, 237,025 late preterm births met eligibility criteria, of which 17.3% were exposed to antenatal steroids. Among the following sociodemographic factors, the odds of antenatal steroid receipt were lower compared to the reference majority population: 1) Black (adjusted odds ratio (aOR) 0.88 (95% CI 0.81, 0.96)) and Native Hawaiian or Other Pacific Islander (NHOPI) (aOR 0.58 (95% CI 0.43, 0.79) compared to White race; 2) less than high school education (aOR 0.76 (95% CI 0.72, 0.81)) or high school education (Aor 0.87 (95% CI 0.83, 0.91)) compared to post-secondary education; and 3) public (aOR 0.83 (95% CI 0.78, 0.87)) or no insurance (aOR 0.68 (95% CI 0.61, 0.77)) compared to private insurance. Age and marital status were not associated with steroid receipt. Despite no known differential treatment effects of antenatal steroids by sociodemographic factors, steroid exposure among LBPs varied significantly among races, ethnicities, payers, and education levels in the US. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data used in this analysis are available online at cdc.gov.