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Am J Perinatol 2022; 39(11): 1204-1211
DOI: 10.1055/s-0040-1721717
Original Article

Is Appropriate Administration of Antenatal Corticosteroids Associated with Maternal Race?

Devlynne S. Ondusko 
1   Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
,
Bharti Garg
2   Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
,
Aaron B. Caughey
2   Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
,
Rachel A. Pilliod
2   Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
,
Emily H. Carter
1   Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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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.

Keywords

antenatal corticosteroid - race - ethnicity - preterm - neonate


Publication History

Received: 28 August 2020

Accepted: 04 November 2020

Article published online:
29 December 2020

© 2020. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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