Document Type

Article

Publication Date

5-17-2026

Comments

This article is the author's final published version in The Journal of Maternal-Fetal and Neonatal Medicine, Volume 39, Issue 1, December 2026, Article number 2670754.

The published version is available at https://doi.org/10.1080/14767058.2026.2670754. Copyright © 2026 The author(s).

Abstract

BACKGROUND: The Society for Maternal Fetal Medicine (SMFM) provides guidance on the use of antenatal corticosteroids, antibiotics, and cesarean delivery in the periviable period. Although racial differences exist in postnatal active management of periviable neonates have been described, less is known about racial differences in antenatal interventions preceding delivery.

OBJECTIVE: To evaluate differences in the receipt of antenatal interventions before periviable delivery by birthing parent race.

METHODS:  We conducted a population-based cohort study using the National Center for Health Statistics database including periviable deliveries (20w0d-25w6d) from 2016-2021. Individuals delivering a non-anomalous live singleton gestation in a hospital were included. Births with birthweight >97th percentile for gestational age were excluded to minimize dating errors. The exposure was self-reported race with non-Hispanic White as the reference group. Outcomes included antenatal corticosteroid administration, antibiotic administration, and cesarean delivery. Multivariable logistic regression adjusted for maternal age, body mass index, insurance status, marital status, nulliparity, prior preterm birth, diabetes, hypertensive disorders of pregnancy, chronic hypertension, gestational age, and year of delivery.

RESULTS:  Among 55,306 periviable births, 31.2% occurred in non-Hispanic White parents, 35.1% Black, 23.9% Hispanic, 4.5% Asian. Antenatal corticosteroids were administered to 36.7% of non-Hispanic white parents compared with 32.9% of Black, 31.8% of Hispanic, and 30.5% of Asian parents. After adjustment, Black, Hispanic, and Asian parents had lower odds of receiving corticosteroids (aOR 0.84, 0.86, 0.74, respectively; all p < 0.001). Black parents were also less likely to receive antibiotics (aOR 0.94, p < 0.005). Cesarean delivery occurred less frequently in Asian parents (aOR 0.76, p < 0.001).

CONCLUSION(S): Differences in the receipt of antenatal interventions were observed across racial groups in the periviable period. Further research is needed to better understand the factors contributing to these differences and to support equitable, patient-centered care.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

42144379

Language

English

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