Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon.
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Am J Perinatol. 2022 Aug;39(11):1204-1211. doi: 10.1055/s-0040-1721717. Epub 2020 Dec 29.
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).
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.
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.
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.
· 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..
产前皮质激素（ACS）可改善早产儿的结局；然而，并非所有有早产风险的孕妇都接受 ACS 治疗。少数族裔获得充分产前护理的可能性较低，早产的可能性较高。本研究的目的是确定在华盛顿州，对于有早产风险（23-34 周）的妇女，产妇种族是否与 ACS 使用率较低有关。
这是一项基于人群的回顾性队列研究，纳入了 2007 年至 2014 年华盛顿州单胎、非畸形、早产分娩的女性。描述性数据包括产妇社会人口统计学、妊娠并发症、分娩机构和新生儿特征。主要结局是产妇接受 ACS 治疗，自变量是产妇种族/民族。次要结局包括新生儿需要辅助通气，包括立即和超过 6 小时，以及表面活性剂的使用。使用卡方检验和 logistic 回归模型进行数据分析。
共有 8530 名非畸形、单胎新生儿在 23-34 周的胎龄分娩。其中，55.8%的母亲自认为是白人，7.5%是黑人，21.4%是西班牙裔，10.9%是亚裔，4.3%是美洲原住民。调整混杂因素后，黑人和新生儿的 ACS 使用率显著降低（调整后的优势比[aOR]为 0.62；95%置信区间[CI]：0.51-0.76），分娩后立即使用辅助通气（aOR 为 0.76；95% CI：0.61-0.94）和超过 6 小时（aOR 为 0.64；95% CI：0.49-0.84）以及表面活性剂治疗（aOR 为 0.62；95% CI：0.42-0.92）也显著降低。
这些发现通过描述有早产风险的孕妇 ACS 使用率的种族差异，为当前的文献提供了新的认识。为了更好地理解黑人和 ACS 使用率之间的关联，未来的研究应该关注医院内部和之间的差异（包括质量、位置、资源）、患者健康素养、健康的社会决定因素以及系统性种族主义和歧视的暴露情况。
黑人妇女接受产前类固醇治疗的可能性较低。黑人新生儿接受呼吸支持的可能性较低。黑人新生儿接受表面活性剂治疗的可能性较低。
