Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants’ likelihood of survival.
Objective Our aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births.
Methods The population included 1020 singleton births between 220/6 and 260/6 weeks of gestation enrolled in the Etude Epidémiologique sur les Petits Ages Gestationnels 2 study, a French national population-based cohort of very preterm infants born in 2011. The main outcome was ‘active antenatal care’ defined as the administration of either corticosteroids or magnesium sulfate or delivery by caesarean section for fetal rescue. A multivariable analysis was performed using a two-level multilevel model taking into account the maternity unit of delivery to estimate the adjusted ORs (aORs) of receiving active antenatal care associated with maternal, obstetric and place of birth characteristics.
Results Among the population of extremely preterm births, 42% received active antenatal care. After standardisation for gestational age, regional rates of active antenatal care varied between 22% (95% CI 5% to 38%) and 61% (95% CI 44% to 78%). Despite adjustment for individual and organisational characteristics, active antenatal care varied significantly between maternity units (p=0.03). Rates of active antenatal care increased with gestational age with an aOR of 6.46 (95% CI 3.40 to 12.27) and 10.09 (95% CI 5.26 to 19.36) for infants born at 25 and 26 weeks’ gestation compared with those born at 24 weeks. No other individual characteristic was associated with active antenatal care.
Conclusion Even after standardisation for gestational age, active antenatal care in France for extremely preterm births varies widely with place of birth. The dependence of life and death decisions on place of birth raises serious ethical questions.
- Extreme preterm birth
- active antenatal care
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Contributors CD, FG, GK, PYA, EA and LFH conceived and designed the study. VB participated in the data collection. CD, FG, LFH and BK performed the statistical analysis. CD, FG and LFH interpreted the data helped by EL, GK, JCR, PB, MK and PYA. CD, FG, LFH, PYA and EA wrote the manuscript. EL, GK, JCR, PB, BL, LS, DS and MK reviewed the manuscript and made significant changes. All authors read and approved the final manuscript.
Competing interests None declared.
Patient consent Consent obtained from the guardian.
Ethics approval Consultative Committee on the Treatment of Information on Personal Health Data for ResearchPurposes (no 10.626); Committee for the Protection of People participating in Biomedical Research (no CPP SC-2873); The National Data Protection Authority(CNIL no 911009).
Provenance and peer review Not commissioned; externally peer reviewed.
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