Investigating racial differences in the receipt of antenatal interventions prior to periviable delivery

The Society for Maternal Fetal Medicine (SMFM) provides guidance on the use of antenatal corticosteroids, antibiotics, and cesarean delivery in the periviable period. Although racial differences exist in postnatal active management of periviable neonates have been described, less is known about racial differences in antenatal interventions preceding delivery.

To evaluate differences in the receipt of antenatal interventions before periviable delivery by birthing parent race.

We conducted a population-based cohort study using the National Center for Health Statistics database including periviable deliveries (20w0d-25w6d) from 2016-2021. Individuals delivering a non-anomalous live singleton gestation in a hospital were included. Births with birthweight >97^th percentile for gestational age were excluded to minimize dating errors. The exposure was self-reported race with non-Hispanic White as the reference group. Outcomes included antenatal corticosteroid administration, antibiotic administration, and cesarean delivery. Multivariable logistic regression adjusted for maternal age, body mass index, insurance status, marital status, nulliparity, prior preterm birth, diabetes, hypertensive disorders of pregnancy, chronic hypertension, gestational age, and year of delivery.

Among 55,306 periviable births, 31.2% occurred in non-Hispanic White parents, 35.1% Black, 23.9% Hispanic, 4.5% Asian. Antenatal corticosteroids were administered to 36.7% of non-Hispanic white parents compared with 32.9% of Black, 31.8% of Hispanic, and 30.5% of Asian parents. After adjustment, Black, Hispanic, and Asian parents had lower odds of receiving corticosteroids (aOR 0.84, 0.86, 0.74, respectively; all p < 0.001). Black parents were also less likely to receive antibiotics (aOR 0.94, p < 0.005). Cesarean delivery occurred less frequently in Asian parents (aOR 0.76, p < 0.001).

Differences in the receipt of antenatal interventions were observed across racial groups in the periviable period. Further research is needed to better understand the factors contributing to these differences and to support equitable, patient-centered care.