Association of active antenatal management in the periviable period and parental morbidity in the United States

Objective: The objective of this study is to describe the incidence of parental morbidity with periviable delivery and its relationship to antenatal interventions, including antenatal corticosteroids, antibiotics, and cesarean delivery. Study Design: This is a population-based case-control study of the National Center for Health Statistics database of periviable deliveries (20w0d-25w6d) from 2016-2021. Subjects were included if they delivered a non-anomalous live singleton gestation in a hospital. To minimize inaccurate dating, subjects were excluded for birthweight >97% for gestational age. The composite morbidity outcome was defined as parental blood transfusion, intensive care unit (ICU) admission, or unplanned hysterectomy. We assessed this outcome’s relationship to parental demographic and clinical characteristics, including the receipt of selected antenatal interventions including antenatal corticosteroids, antibiotics and cesarean delivery. Multivariable logistic regression was used to assess the relationship of antenatal intervention and parental morbidity. Results: Of 45,339,472 births during the study period, 93,686 met inclusion criteria for this study. 2726 (3.1%) parents experienced parental morbidity. The rate of perinatal morbidity increased over the study period. Black parents were less likely to experience morbidity compared to non-Black parents (2.7% versus 3.4%, p<0.001). Parents who received antenatal steroids or antibiotics and those undergoing cesarean delivery had higher rates of morbidity compared to their counterparts who did not receive these interventions. Conclusions: Birthing parents who received steroids or antibiotics prior to periviable delivery and those undergoing cesarean delivery were more likely to experience parental morbidity of transfusion, hysterectomy, or ICU admission. The relationship of these interventions, intended to improve neonatal outcomes or prolong pregnancy, to parental morbidity should be incorporated into the nuanced counseling required in parents at risk of periviable deliveries. Additional research is warranted to understand the institutional, provider, and patient factors underlying these findings.