TY - JOUR T1 - Providing active antenatal care depends on the place of birth for extremely preterm births: the EPIPAGE 2 cohort study JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed SP - F476 LP - F482 DO - 10.1136/archdischild-2016-312322 VL - 102 IS - 6 AU - Caroline Diguisto AU - François Goffinet AU - Elsa Lorthe AU - Gilles Kayem AU - Jean-Christophe Roze AU - Pascal Boileau AU - Babak Khoshnood AU - Valérie Benhammou AU - Bruno Langer AU - Loic Sentilhes AU - Damien Subtil AU - Elie Azria AU - Monique Kaminski AU - Pierre-Yves Ancel AU - Laurence Foix–L’Hélias Y1 - 2017/11/01 UR - http://fn.bmj.com/content/102/6/F476.abstract N2 - 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. ER -