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Poster Session 4

(1220) Association of active antenatal management before periviable birth and birthing parent race in the US

Friday, January 31, 2025
4:00 PM – 6:00 PM  
Objective: sMFM provides guidance on the use of antenatal corticosteroids, antibiotics, and cesarean delivery in the periviable period. Although differences exist in postnatal active management of periviable neonates by parent race, less is known about the receipt of antenatal interventions. The objective of this study is to describe differences in antenatal interventions before a periviable delivery by birthing parent race.

Study Design:

This is a population-based cohort study of the National Center for Health Statistics database of periviable deliveries (20w0d-25w6d) from 2016-2021. Subjects were included if they delivered a non-anomalous live singleton gestation in a hospital. To minimize inaccurate dating, subjects were excluded for birthweight >97% for gestational age. The exposure was self-reported race; those of Black race were compared to those of non-Black race. Outcomes included receipt of antenatal steroids or antibiotics, and cesarean delivery. The relationship of race to antenatal interventions was assessed using multivariable logistic regression.


Results: Of 45339472 live births during the study period, 93686 met inclusion criteria for this study. 37626 (40.2%) periviable births occurred in Black subjects. Black subjects differed from non-Black subjects in baseline characteristics (Table 1). As seen in Table 2, Black subjects were less likely to receive antenatal steroids (33.5% v. 34.3%, aOR 0.93, 95% CI 0.90-0.96), receive antibiotics (36.8% v. 38.1%, aOR 0.96, 95% 0.93-0.99), or receive antibiotics in the presence of intraamniotic infection(64.7% v. 67.4%, aOR 0.87, 95% CI 0.78-0.97). There were no differences in mode of delivery in adjusted analyses.

Conclusion: Black birthing parents are less likely to receive antenatal steroids or antibiotics prior to a periviable delivery. Given the complexity of counseling and clinical-decision making required in those at risk of periviable birth, additional research is warranted to understand the root of these disparities with the goal of equitable, patient-centered care in the periviable period.