A new global analysis of two antenatal treatments that reduce the risk of cerebral palsy and respiratory complications in premature babies reveals significant international variation in implementation. The University of Bristol-led study, published in the International Journal of Obstetrics & Gynaecology today (25 February), examined neonatal data from over 300,000 premature births across ten countries.
When a baby is born before 30 weeks of gestation, they have a higher risk of death or serious health challenges, including stroke, respiratory problems, and disabilities like cerebral palsy. Magnesium sulphate is a cost-effective treatment that, when given to the mother before a pre-term birth, can significantly reduce the risk of cerebral palsy in the baby. Similarly, antenatal steroids are crucial for maturing a preterm baby’s lungs to improve their chances of survival.
Despite being recommended in clinical guidelines worldwide, this study highlights significant disparities in the administration of these life-saving treatments to mothers at risk of preterm birth.
Led by researchers from the University of Bristol’s Medical School and the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), the study used neonatal birth data on 45,619 babies born prematurely (between 24–32 weeks’ gestation) in 1,111 Vermont Oxford Network (VON) hospitals across ten countries: UK, Ireland, Austria, Switzerland, Italy, US, UAE, Brazil, South Africa, and India. The team conducted a further supplementary review of ten studies that included data on 288,631 pre-term babies, and a comparison of the VON data against the wider population of English data from the UK National Neonatal Research Database.
The results revealed stark contrasts in the use of magnesium sulfate (MgSO4). Countries like Ireland and the UK had high administration rates (over 80%), while South Africa and the UAE had much lower rates, at 33.6% and 44.5%, respectively. In contrast, antenatal corticosteroids (ANS) were used more consistently across countries, with less variation.
Significant income-related disparities were also uncovered. Higher-income countries averaged 74.8% MgSO4 implementation compared to just 49.4% in middle-income countries. Concerningly, this equity gap has not narrowed over time. The supplementary review found treatment rates similar to those in the VON cohort.
The study concludes that there is considerable variation in the use of these interventions globally, with much lower uptake in middle income countries. It calls for further research to understand the reasons for these disparities and to improve the global equity of these essential antenatal treatments.
Hannah Edwards, Senior Research Associate in Medical Statistics at the University of Bristol and ARC West, said: “Our study has highlighted the international disparities in how two key treatments to protect pre-term babies are implemented. These gaps aren’t because of a lack of evidence.
“Lessons can be learned from successful implementation programmes like PReCePT, which has transformed use of magnesium sulphate in pre-term births in England. The bigger-picture goal now should be to ensure that no matter where a baby is born, their mother has access to the evidence-based treatments that offer the best start in life.”
Karen Luyt, PReCePT national clinical lead and Professor of Neonatal Medicine at the University of Bristol, added: “This work highlights the power of international collaboration to achieve health equity for mothers and babies everywhere.
“At the moment, the use of MgSO4 to prevent cerebral palsy in pre-term infants is not equitable around the world. Our PReCePT blueprint for successful implementation of this life changing medication will be useful for accelerating use into routine clinical practice across international healthcare systems.”
This research was funded by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West).
Paper
‘International disparities in use of antenatal magnesium sulfate and antenatal steroids for the preterm baby’ by H Edwards et al. in the International Journal of Gynecology & Obstetrics
Further information
Summary of key findings
- Wide disparities in use: There are stark differences in how often these treatments are used between different countries, and even between individual hospitals,
- The implementation gap: Despite strong evidence that these treatments work and are cost-effective, many eligible mothers are still not receiving them,
- National success stories: Some regions, such as England through the PReCePT programme, have shown significant improvements in MgSO4 uptake, providing a model for other nations,
- Steroids vs magnesium sulphate: While the use of steroids is generally higher and more consistent, the use of magnesium sulphate lags behind in many international cohorts.
About the National Institute for Health and Care Research (NIHR)
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. It does this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK international development funding from the UK government.
About the NIHR Applied Research Collaboration West (NIHR ARC West)
The NIHR Applied Research Collaboration West (ARC West) conducts applied health research with its partners and others in the health and care sector, alongside patients and members of the public. Applied health research aims to address the immediate issues facing the health and social care system. ARC West also helps bring research evidence into practice and provides training for the local workforce.
About VON
VON is a worldwide community dedicated to improving the quality, safety, and value of care for newborn infants and their families through a coordinated program of data-driven quality improvement, education, and research. Members use the world’s largest, most comprehensive databases of infant data to benchmark practices and outcomes and identify areas for improvement. VON supports collaborative QI by connecting teams, providing evidence-based practices, and guiding teams through the Sequence to Achieve Change quality improvement roadmap.
