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Is Appropriate Administration of Antenatal Corticosteroids Associated with Maternal Race?
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- Author(s): Ondusko, Devlynne S.; Garg, Bharti; Caughey, Aaron B.; Pilliod, Rachel A.; Carter, Emily H.
- Source:
American Journal of Perinatology; Aug2022, Vol. 39 Issue 11, p1204-1211, 8p- Subject Terms:
PREVENTION of racism; RISK factors in premature labor; EVALUATION of medical care; ADRENOCORTICAL hormones; MINORITIES; CONFIDENCE intervals; PREGNANT women; MEDICAL care; RACE; GESTATIONAL age; RETROSPECTIVE studies; DRUG administration; RISK assessment; ARTIFICIAL respiration; CHI-squared test; DESCRIPTIVE statistics; PRENATAL care; POPULATION health; ETHNIC groups; LOGISTIC regression analysis; ODDS ratio; LONGITUDINAL method - Source:
- Additional Information
- Subject Terms:
- Abstract: Objective Antenatal corticosteroids (ACSs) improve outcomes for premature infants; however, not all pregnant women at risk for preterm delivery receive ACS. Racial minorities are less likely to receive adequate prenatal care and more likely to deliver preterm. The objective of this study was to determine if maternal race is associated with a lower rate of ACS administration in Washington for women at risk of preterm labor (between 23 and 34 weeks). Study Design This was a population-based retrospective cohort study of singleton, nonanomalous, premature deliveries in Washington state between 2007 and 2014. Descriptive data included maternal sociodemographics, pregnancy complications, facility of birth, and neonatal characteristics. The primary outcome was maternal receipt of ACS and the independent variable was maternal race/ethnicity. The secondary outcomes included neonatal need for assisted ventilation, both initially and for more than 6 hours, and administration of surfactant. Data were analyzed using chi-square tests and logistic regression models. Results A total of 8,530 nonanomalous, singleton neonates were born between 23 and 34 weeks' gestation. Of those, 55.8% of mothers were self-identified as white, 7.5% as black, 21.4% as Hispanic, 10.9% as Asian, and 4.3% as Native American. After adjusting for confounders, black woman–neonate dyads had significantly lower odds of receiving ACS, (adjusted odds ratio [aOR] = 0.62; 95% confidence interval [CI]: 0.51–0.76), assisted ventilation immediately following delivery (aOR = 0.76; 95% CI: 0.61–0.94) and for more than 6 hours (aOR = 0.64; 95% CI: 0.49–0.84) and surfactant therapy (aOR = 0.62; 95% CI: 0.42–0.92) as compared with whites. Conclusion These findings contribute to the current body of literature by describing racial disparities in ACS administration for pregnant women at risk for preterm delivery. To better understand the association between black race and administration of ACS, future studies should focus on differences within and between hospitals (including quality, location, resources), patient health literacy, social determinants of health, and exposure to systemic racism and discrimination. Key Points Black women were less likely to receive antenatal steroids. Black neonates had lower odds of respiratory support. Black neonates had lower odds of receiving surfactant. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of American Journal of Perinatology is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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