Racial disparities in the administration of antenatal corticosteroids in women with preterm birth

Abstract

Racial and ethnic disparities in maternal and neonatal outcomes are a major concern in the United States.1ACOG committee opinion no. 649: racial and ethnic disparities in obstetrics and gynecology.Obstet Gynecol. 2015; 126: e130-e134Crossref PubMed Scopus (10) Google Scholar, 2Howell E.A. Zeitlin J. Quality of care and disparities in obstetrics.Obstet Gynecol Clin North Am. 2017; 44: 13-25Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 3Willis E. McManus P. Magallanes N. Johnson S. Majnik A. Conquering racial disparities in perinatal outcomes.Clin Perinatol. 2014; 41: 847-875Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar The American College of Obstetricians and Gynecologists has advocated for raising awareness, promoting research and education, and determining effective measures to identify existing barriers in the efforts to reduce such disparities.1ACOG committee opinion no. 649: racial and ethnic disparities in obstetrics and gynecology.Obstet Gynecol. 2015; 126: e130-e134Crossref PubMed Scopus (10) Google Scholar We sought to determine whether there is a racial or ethnic disparity in the administration of antenatal corticosteroids (ACSs) in women with preterm births between 23 and 34 weeks of gestation. This retrospective cohort study utilized the US Natality Live Birth database from the Centers for Disease Control and Prevention for the years 2016–2017.4CDC Wonder Natality Information: Natality for 2016-2017 (expanded)Centers for Disease Control and Prevention.https://wonder.cdc.gov/natality.htmlDate accessed: July 28, 2019Google Scholar Women with in-hospital preterm births between 23 and 34 weeks of gestation were eligible for analysis. Data regarding the administration of ACSs, defined by the Natality database as ACSs for fetal lung maturation received by the mother before delivery, were extracted in cases of preterm birth. Cases where ACS exposure was unknown were excluded. Maternal race or ethnicity was self-identified on the birth certificate and characterized as non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic. The incidence of ACS administration was compared among the maternal race or ethnic groups using the Pearson chi-squared test with statistical significance set at P<0.05. The comparison was further evaluated for each gestational week. In addition, multivariable logistic regression was performed to account for the following confounding variables: proportion of women of age >35 years, nulliparity, marital status, higher education, private health insurance, no prenatal care, gestational or prepregnancy diabetes, history of preterm birth, tobacco use, infertility treatment, or birth by cesarean delivery. Data were presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). An institutional review board approval was not required as the reported deidentified data are publicly available through a data use agreement with the National Center for Health Statistics.5Data use restrictionsCenters for Disease Control and Prevention.https://wonder.cdc.gov/DataUse.htmlDate accessed: July 28, 2019Google Scholar The study cohort included 183,084 preterm births between 23 and 34 weeks of gestation. Of those, 89,278 (48.8%) were NHW, 50,140 (27.4%) were NHB, and 43,666 (23.8%) were Hispanic. There was a significant difference in the overall rate of administration of ACSs among the 3 groups (NHW, 39,741 of 89,278 [44.5%]; NHB, 18,947 of 50,140 [37.8%]; Hispanic, 16,075 of 43,666 [36.8%]; P<.0001). The rate of ACS administration at each week between 23 and 34 weeks of gestation was significantly lower in NHB and Hispanic women than in NHW women (P<.0001) (Figure). This rate remained significantly lower for NHB and Hispanic women after independently controlling for all confounding variables (NHW [OR, 1], NHB [adjusted OR (AOR), 0.83; 95% CI, 0.81–0.85], Hispanic [AOR, 0.80; 95% CI, 0.78–0.82]). Our study showed a significant racial and ethnic disparity in the administration of ACSs before preterm births between 23 and 34 weeks of gestation. NHB and Hispanic race and ethnicity were independent risk factors for lower administration of ACSs. Given the higher prevalence for preterm birth in NHB women,6Goldenberg R.L. Culhane J.F. Iams J.D. Romero R. Epidemiology and causes of preterm birth.Lancet. 2008; 371: 75-84Abstract Full Text Full Text PDF PubMed Scopus (4603) Google Scholar our findings of suboptimal administration of ACSs in this population were of particular concern and might have significant neonatal health implications. Further research is needed to identify the reasons for this disparity.