{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T02:47:36Z","timestamp":1782096456044,"version":"3.54.5"},"posted":{"date-parts":[[2026,6,18]]},"group-title":"Obstetrics and Gynecology","reference-count":18,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Heart, Lung, and Blood Institute Division of Intramural Research","award":["R01HL176836"],"award-info":[{"award-number":["R01HL176836"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To determine whether and to what extent hospitals across the United States vary in their use of late-preterm steroids using a novel data set in which the timing of steroid administration relative to delivery can be observed.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective cohort study of singleton births with known gestational ages identified in the Premier Healthcare Database from 2015 to 2022. The primary variable of interest was hospital-level adoption of antenatal corticosteroids for late-preterm singleton deliveries, calculated as the proportion of late-preterm singleton births (34-36 completed weeks of gestation) with any betamethasone exposure during the same late-preterm period. Hospital adoption was defined as the weighted average rate of ALPS administration among late-preterm infants across the entire post-period. Hospitals were ranked by their late-preterm steroid adoption rates and categorized by quartile based on the empirical distribution. Temporal trends were assessed using annual hospital-level adoption rates and visualized using time-series plots and distributional plots. A logistic regression model was constructed to determine hospital characteristics associated with being a highest-quartile adopting hospital.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The analysis cohort included 728 hospitals and 5,452,791 births, of which 361,006 (6.6%) were singleton late preterm births. Hospital steroid exposure rates ranged from 0 to 82% and were categorized into quartiles based on overall exposure rate, with cutoffs at 20.6%, 29.8%, and 40.1%. Median exposure rates increased progressively across quartiles from 14.1% (IQR 9.3-17.4%) in the lowest adopting hospitals (Q1) to 47.6% (IQR 43.7-53.2%) in the highest adopting hospitals (Q4), with substantial within-quartile variation. In the multivariable model, urban location was a strong predictor of high adoption after adjustment (aOR 2.05; 95% CI 1.11-3.83, p=0.02). Compared to Midwest hospitals, Southern hospitals had significantly lower odds of being high adopters (aOR 0.37; 95% CI 0.20-0.69, p&lt;0.01). Among clinical case mix variables, a higher proportion of late preterm births at 34 weeks\u2019 gestation was strongly associated with high adoption (aOR 2.21; 95% CI 1.58-3.14, p&lt;0.001).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Following publication of the ALPS Trial, there was heterogeneous adoption of late preterm steroids among US hospitals. These findings highlight the need for a more in-depth exploration of local factors that drive the adoption of evidence-based practices outside of observable hospital characteristics.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.09.26355014","type":"posted-content","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:11:04Z","timestamp":1781827864000},"source":"Crossref","is-referenced-by-count":0,"title":["Hospital-Level Variation in Antenatal Corticosteroids for Late Preterm Births"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5568-4444","authenticated-orcid":false,"given":"Mark A.","family":"Clapp","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dohyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siguo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn E.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Lorch","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Gyamfi-Bannerman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, UC San Diego, San Diego, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali J.","family":"Kaimal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Melamed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026062119050638000_2026.06.09.26355014v1.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1516783"},{"key":"2026062119050638000_2026.06.09.26355014v1.2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004454.pub3"},{"key":"2026062119050638000_2026.06.09.26355014v1.3","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001715"},{"key":"2026062119050638000_2026.06.09.26355014v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.03.013"},{"key":"2026062119050638000_2026.06.09.26355014v1.5","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.12702"},{"key":"2026062119050638000_2026.06.09.26355014v1.6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.50830"},{"key":"2026062119050638000_2026.06.09.26355014v1.7","unstructured":"Data | Premier Products. 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