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Published on: January 12, 2018
Regional and Racial-Ethnic Differences in Perinatal Interventions Among Periviable Births.
Nansi S Boghossian1, Marco Geraci, Erika M Edwards
1Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; the Vermont Oxford Network, the Department of Mathematics and Statistics, University of Vermont, and the Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont; and the Department of Obstetrics & Gynecology, the University of Texas Medical Branch at Galveston, Galveston, Texas.
Regional differences in perinatal interventions for periviable gestations are significant, especially for 22- and 23-week neonates. Minority neonates in the Northeast and West regions received more postnatal life support.
Area of Science:
- Neonatal medicine
- Perinatal care
- Public health
Background:
- Perinatal interventions for periviable gestations (22-25 weeks) vary significantly.
- Understanding regional and racial-ethnic disparities in these interventions is crucial for equitable care.
Purpose of the Study:
- To investigate regional variations in three key perinatal interventions for periviable gestations.
- To examine racial-ethnic differences in receiving these interventions, controlling for hospital region.
Main Methods:
- Retrospective study of 776 U.S. centers (Vermont Oxford Network, 2006-2017) for neonates born at 22-25 weeks gestational age.
- Primary outcome: postnatal life support. Secondary outcomes: antenatal corticosteroid administration, cesarean delivery.
- Analysis included regional rates and adjusted relative risks (aRRs) for racial-ethnic disparities using modified Poisson regression.
Main Results:
- Significant regional variation in interventions was observed for 22- and 23-week gestations, but not for 24- and 25-week gestations.
- Life support rates at 22 weeks were higher in the South and Midwest compared to the Northeast and West.
- In the Northeast and West, Black and Hispanic neonates (22-23 weeks) had higher provision of postnatal life support than White neonates.
Conclusions:
- Substantial regional disparities exist in perinatal interventions for neonates born at 22 and 23 weeks of gestation.
- Minority neonates in the Northeast and West regions experienced higher rates of postnatal life support.
- These findings highlight the need to address inequities in perinatal care for vulnerable populations.
