Journal Article

Providing active antenatal care depends on the place of birth for extremely preterm births: the EPIPAGE 2 cohort study

Boileau, Pascal, Ancel, Pierre-Yves, Roze, Jean-Christophe, Langer, Bruno, Sentilhes, Loic, Kayem, Gilles, Lorthe, Elsa, Benhammou, Valérie, Khoshnood, Babak, Goffinet, François, Azria, Elie, Diguisto, Caroline, Subtil, Damien, Kaminski, Monique, Foix–L’Hélias, Laurence

2017

Overview

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.ObjectiveOur aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births.MethodsThe 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.ResultsAmong 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.ConclusionEven 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.

• Publisher: BMJ Publishing Group,CCSD,BMJ Publishing Group LTD
• Subject: Adult / Age / Clinical decision making / Cohort analysis / Cohort Studies / Corticoids / Decision making / Female / Food and Nutrition / France - epidemiology / Gestational Age / Health risk assessment / Human health and pathology / Humans / Hypertension / Infant / Infant Mortality / Infant, Extremely Premature / Infant, Newborn / Infants / Intensive care / Life Sciences / Magnesium sulfate / Male / Mortality / Newborn babies / Obstetrics / Onsite / Pediatrics / Population / Pregnancy / Premature birth / Prenatal care / Prenatal Care - statistics & numerical data / Residence Characteristics - statistics & numerical data / Stillbirth / Survival / Survival Rate