Disparities in Antenatal Corticosteroid Treatment to women experiencing threatened preterm delivery
Antenatal Corticosteroid Treatment (ACT) is an evidence-based beneficial intervention to prevent neonatal complications associated with preterm birth (PTD). The administration of corticosteroid to women experiencing threatened PTD when administered at least 24 hours prior to delivery has been shown to decrease the incidence of neonatal morbidity and mortality.
Disparity in ACT between the majority Jewish population and the Bedouin-Arabs minority population has been documented in southern Israel, where all citizens are covered by National Health Insurance, and served by Soroka University Medical Center (SUMC), the only hospital in the region. The aim of the study is to identify factors associated with disparity in ACT in the region.
METHODS:
The study is a population-based retrospective cohort, including all preterm births (24 to 34 weeks of gestation) in SUMC, between 1/2006 - 2/2010. Socio-demographic characteristics, obstetric history, the course of the pregnancy and birth outcomes were extracted from medical records. During the study period there were 1083 eligible PTBs, of which 821 were medically eligible for ACT.
RESULTS:
ACT was not received by 23.63% (n=194) of the women (28.4% in Bedouins vs. 16.7% in Jews, P<0.001). The most important factor associated with no ACT was arriving too late to the hospital (OR=13.8,95%CI:8.8-21.1). Adjusting for time of arrival and for presenting symptoms at admission, the difference between Jews and Bedouins in rates of ACT administration became insignificant.
CONCLUSIONS:
Women and men at child-bearing age should be educated on the signs and symptoms of premature labor and on the importance of timely seeking medical help when symptoms occur.