Development and validation of a prediction tool to optimize antenatal corticosteroid timing in patients at risk of spontaneous preterm birth

Abstract

Abstract Introduction The objective of this study was to develop and validate a preterm birth (PTB) prediction model to optimize the timing of antenatal corticosteroid (ACS) administration in patients at risk of spontaneous PTB. Methods Secondary analysis of the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers‐to‐Be) prospective cohort study including participants who received ACS due to increased risk for spontaneous PTB (i.e., development cohort). Nulliparous participants presenting between 23 0/7 and 36 6/7 weeks of gestation were eligible for inclusion and were characterized into two groups based on the time interval from the first dose of ACS administration to delivery: ≤7 versus >7 days. Multivariable logistic regression was utilized to assess clinical characteristics at the time of the first dose of ACS administration as candidate predictors for optimal ACS timing, defined as delivery within 7 days of ACS administration. We then externally validated the model using data from patients at risk for spontaneous PTB at two academic centers. The predictive performance of each model was assessed using area under the receiver operating curve (ROC AUC), precision, and recall scores with 95% confidence intervals (CIs). Results Key predictors for optimal ACS timing were rupture of membranes, cervical dilation and effacement at admission, maternal age, and gravidity. In the development cohort, the model achieved an AUC of 0.84 (95% CI, 0.77–0.92). External validation of these models in two independent cohorts demonstrated consistent performances (AUC, 0.82; 95% CI, 0.75–0.88 and AUC, 0.81; 95% CI, 0.72–0.89). Conclusion We successfully developed and externally validated a model that predicts whether nulliparas are expected to deliver within 7 days of ACS administration. Further studies can assess whether incorporating this model into clinical practice improves neonatal outcomes.