Antenatal magnesium sulphate for neuroprotection of preterm babies: data analysis of inequities in treatment in England 2014 to 2024

ObjectivesTo identify (a) sociodemographic inequities in treatment with antenatal MgSO4 for fetal neuroprotection in preterm birth, and (b) whether any inequities have improved following implementation of a national quality improvement programme to improve use of MgSO4. DesignSecondary data analysis study using adjusted logistic regression modelling. SettingNHS England maternity units from 2014 to 2024. ParticipantsMothers with a preterm baby born from 24 to under 30 weeks gestation and admitted to an NHS neonatal unit. OutcomesReceipt of antenatal MgSO4. ResultsBefore implementation of the National PReCePT (Preventing Cerebral Palsy in Pre-Term labour) Programme (NPP), mothers from the North of England had lower odds of MgSO4 treatment than mothers from the South of England (OR 0.60, 95% CI 0.49 to 0.74, p<0.001). Following implementation of the NPP, there was no longer evidence for a regional inequity in treatment (OR 0.87, 95% CI 0.70 to 1.08, p=0.201). Pre-NPP, mothers from more deprived areas had lower odds of treatment than women from more affluent areas (OR 0.87, 95% CI 0.80 to 0.95, p=0.002), but again, post-NPP, there was no longer evidence for inequity by deprivation (OR 1.02, 95% CI 0.92 to 1.14, p=0.719, p-value for interaction=0.022). White British mothers had slightly lower odds of treatment than mothers of other ethnic groups (OR 0.93, 95% CI 0.87 to 1.00, p=0.038), and this inequity did not appear to change from pre to post-NPP (p-value for interaction=0.235). There was little evidence that maternal age affected odds of treatment. ConclusionsInequities in delivery of antenatal MgSO4 treatment for preterm birth have improved in England, following implementation of the National PReCePT quality improvement programme. STRENGTHS AND LIMITATIONS OF THIS STUDYStrengths: O_LIStudy uses standardised, routinely, prospectively collected healthcare data from all NHS neonatal units in England reporting on about 40,000 preterm births. C_LIO_LIData covered a 10-year period (2014 to 2024) and the intervention was implemented in 2018, which gives sufficient time for reliable trends to be observed. C_LIO_LIStatistical modelling estimated the total effects of each risk factor separately, adjusted for measured confounders, and models were developed a priori using Directed Acyclic Graphs. C_LI Limitations: O_LIThe dataset only includes data on live-born infants (and their mothers) who were admitted to a neonatal unit. C_LIO_LIThere are other individual characteristics that could also affect equity of care that were not measured in this data and so could not be evaluated here. C_LI What is already known on this topicO_LIUptake of antenatal magnesium sulphate (MgSO4), a neuroprotective treatment to protect against cerebral palsy in preterm births, has recently improved in England. C_LIO_LIThis is at least in part due to implementation of a national quality improvement programme (PReCePT) designed to improve use of MgSO4. C_LIO_LIBut there are persistent inequities in many aspects of maternity and perinatal care in England, and overall improvements in care do not imply improvements in equity. C_LI What this study addsO_LIBefore implementation of PReCePT, mothers from the North of England, from more socioeconomically deprived areas, or were white British ethnicity, all had lower odds of receiving antenatal MgSO4 treatment. C_LIO_LIAfter implementation of PReCePT, antenatal MgSO4 treatment became more equitable with no statistically significant differences in MgSO4 treatment by region or socioeconomic status. C_LI How this study might affect research, practice or policyO_LIPerinatal optimisation programmes should formally evaluate and aim to improve equity of care. C_LI