title: Very preterm birth: who has access to antenatal corticosteroid therapy?
abstract: We describe the administration of antenatal corticosteroid therapy (ACT) for liveborn very preterm neonates in a population-based study. A total of 790 very preterm neonates (between 24 and 31 full weeks of gestation) were included in this regionally defined population of very preterm neonates in France. The main outcome measure was non-access to ACT. Data were analysed using logistic and polytomous models to control for neonatal and sociodemographic characteristics, mechanisms of very preterm birth and neonatal network organisation. As compared with level III, births in levels I-II maternity units were closely related to non-access to ACT (60.1% vs. 8.8%), but not to pregnancy follow-up (19.7% vs. 17.8%). Only 6.3% of very preterm neonates that benefited from antepartum referral did nor receive ACT. Births associated with rupture of membranes and gestational hypertension were significantly more often transferred to level-III units (73.8% and 68.3% respectively) than those due to maternal bleeding and spontaneous labour (57.0% and 50.7% respectively), and the neonates had a lower probability of not receiving ACT (8.5%, 11.5%, 23.0%, 31.2% respectively). Very preterm neonates referred in utero to a level-III unit came from a more favourable socio-economic environment. Non-access to ACT was more often observed in neonates born to 14- to 24-year-old mothers, smokers, of low socio-economic status, and preterm birth resulting from maternal bleeding or spontaneous labour. These data from a French regional study show that access to ACT is not only explained by practitioners' support of recommendations. In our population-based study, ACT access was related to socio-economic factors and to the mechanisms of very preterm birth. Improving the rate of access to ACT should take these organisational, medical and socio-economic dimensions into account.
authors.affiliation: Inserm, CIE1, CHRU Dijon, Centre d'Investigation Clinique - Epidémiologie Clinique/Essais Cliniques, Université de Bourgogne, 21030 Dijon, France. antoine.burguet@chu-dijon.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Burguet
authors.forename: Cyril
authors.initials: C
authors.lastname: Ferdynus
authors.forename: Gérard
authors.initials: G
authors.lastname: Thiriez
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Bouthet
authors.forename: Simon
authors.initials: S
authors.lastname: Kayemba-Kays
authors.forename: Paul
authors.initials: P
authors.lastname: Sanyas
authors.forename: Alain
authors.initials: A
authors.lastname: Menget
authors.forename: Blandine
authors.initials: B
authors.lastname: Mulin
authors.forename: Didier
authors.initials: D
authors.lastname: Riethmuller
authors.forename: Robert
authors.initials: R
authors.lastname: Maillet
authors.forename: Claire
authors.initials: C
authors.lastname: Brousse
authors.forename: Guillaume
authors.initials: G
authors.lastname: Magnin
authors.forename: Philippe
authors.initials: P
authors.lastname: Boisselier
authors.forename: Paul
authors.initials: P
authors.lastname: Sagot
authors.forename: Fabrice
authors.initials: F
authors.lastname: Pierre
authors.forename: Béatrice
authors.initials: B
authors.lastname: Gouyon
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Gouyon
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000600:supply & distribution / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005602:France; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control*; D007234:Infant, Premature; D016015:Logistic Models; D008427:Maternal Health Services / Q000592:standards; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones