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

OBJECTIVES

To identify (a) Sociodemographic differences in treatment with antenatal magnesium sulphate (MgSO4) for fetal neuroprotection in preterm birth and (b) Whether any sociodemographic differences have reduced over time, in conjunction with implementation of a national quality improvement (QI) programme to improve use of MgSO4.

DESIGN

Retrospective cohort study using routinely collected data.

SETTING

NHS England maternity units from 2014 to 2024.

PARTICIPANTS

Mothers with a preterm baby born from 24 to under 30 weeks' gestation and admitted to an NHS neonatal unit.

OUTCOMES: Receipt of antenatal MgSO4.

RESULTS

Before implementation of the National PReCePT (Preventing Cerebral Palsy in Pre-Term Labour) Programme (NPP) in 2018, 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). Following implementation of the NPP, there was no longer evidence for regional differences in treatment (OR 0.87, 95% CI 0.70 to 1.08). 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), but again, post-NPP, there was no longer evidence for difference in use by deprivation status (OR 1.02, 95% CI 0.92 to 1.14, p value for interaction=0.022). White British mothers may have had slightly lower odds of treatment than mothers of other ethnic groups (OR 0.93, 95% CI 0.87 to 1.00), and this potential difference did not appear to change from pre to post-NPP (p value for interaction=0.235). There was little evidence that maternal age affected the odds of treatment.

CONCLUSIONS

Previous sociodemographic differences in receipt of antenatal MgSO4 treatment for preterm birth appear to have equalised in England. This follows, and could be due in part to England's universal implementation of the National PReCePT QI programme.