Evaluation of Prescription Practices for Antenatal Steroids in Pregnant Women

The significant racial disparity in adverse birth outcomes is unexplained by individual-level stressors. This implores us to explore modifiable prenatal care delivery characteristics. Our objective was to evaluate if racial disparities in infant respiratory outcomes were explained by inequitable exposure to antenatal steroids.

We included women who delivered infants between 23 and 34 weeks gestation in Level 3 NICU between January 2017 and December 2020. Prenatal and postnatal variables, including exposure to antenatal steroids, were collected. A community need index was assigned designating level of neighborhood deprivation. Chi squared and t tests were performed to look for racial differences in prenatal and delivery characteristics.

There were no racial differences in steroid administration with 89.9% of eligible Black women and 89.8% of eligible White women completing an antenatal steroid course. Despite no differences in maternal risk factors such as diabetes, pre-eclampsia, prenatal care utilization and PPROM, Black infants were more likely to require intubation (p = 0.04), oxygen (p = 0.001), and surfactant (p = 0.008) in the delivery room compared to White infants. Compared to the lower community need groups exposed to ANS, the high need group had higher rates of chorioamnionitis and were more likely to be on Medicaid and Black race. Despite this, there were no differences in infant respiratory outcomes by community need group.

Despite the shift in focus to include the interaction between individuals and their community exposures, the racial disparity in birth outcomes persists. Attention should be paid to other modifiable elements of a mother's prenatal experience.