92 - Evaluation of Prescription Practices for Antenatal Steroids in Pregnant Women

Poster Number: 92
Publication Number: 92.438

Antalya Jano, University of Pittsburgh School of Medicine, Flushing, NY, United States; Caroline Madigan, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Donald B. DeFranco, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Janet M. Catov, University of Pittsburgh, Pittsburgh, PA, United States; Paris Ekeke, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: Antenatal steroids (ANS) are recommended for pregnant women at risk for preterm delivery. ANS promote fetal lung maturity and may limit the development of pediatric respiratory disease. Existing literature notes significant racial disparity in ANS administration; Black women are less likely to be prescribed ANS than white women (Ondusko, 2020). This finding is of concern given the association between lack of ANS administration and adverse infant outcomes, such as higher intubation rates. The relationship among these trends is poorly understood and may be attributed to socioeconomic and environmental factors.

Objective: We seek to evaluate factors associated with differential prescription practices of ANS in pregnant Black vs. white women at Magee-Womens Hospital (MWH) in Pittsburgh.

Design/Methods: Clinical data on singleton, premature births between 2017 and 2020 were extracted from the Vermont Oxford Network (VON) database. The primary outcome evaluates differences in ANS prescription in pregnant women stratified by race. Secondary outcomes include infant need for assisted ventilation, discharge on oxygen, and surfactant administration. Pearson’s chi-squared test, T-test, and logistic regression models were used for data analysis.

Results: Of 7,880 deliveries, 2,542 (32.2%) were preterm ( < 37 weeks gestational age, GA) and 1,673 (21.2%) occurred between 23- and 34-weeks GA. In the 23-34 week GA cohort, mothers prescribed ANS had higher incidence of maternal hypertension (38.0% vs. 27.0%, P< 0.001) and chorioamnionitis (9.0% vs. 2.7%, P< 0.001), more c-sections (56.9% vs. 48.7%, P=0.005), and more infants with bronchopulmonary dysplasia (BPD) (13.8% vs. 5.9%, P=0.001) compared to mothers without ANS. When stratified by race, Black and white women were prescribed ANS at similar rates (79.9% vs. 78.6%, P=0.592). There were also no differences in surfactant administration (P=0.737) and oxygen (P=0.136) or ventilation (P=0.201) at discharge. Black mothers had higher rates of preterm births (44.4% vs. 38.0%, P< 0.001) and chorioamnionitis (10.3% vs. 6.8%, P=0.023), with lower average birth weight (2272.0g vs. 2447.2g, P< 0.0001) and lower average GA (30.8 weeks vs. 31.6 weeks, P< 0.0001) than white mothers.    Conclusion(s): Although there was no significant difference in ANS prescriptions by race, Black women still had higher rates of preterm birth and chorioamnionitis, and infants with lower average birth weight and GA. Further exploration into social and environmental factors are needed to explain the persistent disparity in preterm birth.
Antalya Jano CVAJanoCV_Jan22.pdf