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Arch Dis Child Fetal Neonatal Ed. 2017 Nov;102(6):F476-F482. doi: 10.1136/archdischild-2016-312322. Epub 2017 Jun 30.

Providing active antenatal care depends on the place of birth for extremely preterm births: the EPIPAGE 2 cohort study.

Author information

Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Maternité Olympe de Gouges, Centre Hospitalier Regional Universitaire Tours, Tours, France.
Université François Rabelais, Tours, France.
DHU Risk in Pregnancy, Maternité Port Royal Paris Descartes University Cochin Broca Hotel Dieu Hospitals Assistance publique des hopitaux de Paris, Paris, France.
UPMC Univ Paris 06, Sorbonne Universités, Paris, France.
Service de Gynécologie Obstétrique, Paris, France.
Service de Néonatologie, CIC 004, INSERM, Nantes University Hospital, Nantes, France.
Service de Néonatologie, CHI Poissy St-Germain-en-Laye, University Versailles StQuentin-en-Yvelines, Versailles, France.
Pole de Gynécologie Obstétrique, Hôpital de Hautepierre, Strasbourg, France.
Department of Obstetrics and Gynecology, University Hospital Bordeaux, Bordeaux, France.
Hôpital Jeanne de Flandre, CHRU-University, Lille Nord, France.
Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, ParisDescartes University, DHU Risk in Pregnancy, Paris, France.
URC CIC P1419, DHU Risk in Pregnancy, Cochin Hotel Dieu Hopital APHP, Paris, France.
Service de Néonatologie, Hopital Armand Trousseau, APHP, Paris, France.


Survival rates of infants born before 25 weeks of gestation are low in France and have not improved over the past decade. Active perinatal care increases these infants' likelihood of survival.


Our aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births.


The population included 1020 singleton births between 220/6 and 260/6 weeks of gestation enrolled in the Etude Epidémiologique sur les Petits Ages Gestationnels 2 study, a French national population-based cohort of very preterm infants born in 2011. The main outcome was 'active antenatal care' defined as the administration of either corticosteroids or magnesium sulfate or delivery by caesarean section for fetal rescue. A multivariable analysis was performed using a two-level multilevel model taking into account the maternity unit of delivery to estimate the adjusted ORs (aORs) of receiving active antenatal care associated with maternal, obstetric and place of birth characteristics.


Among the population of extremely preterm births, 42% received active antenatal care. After standardisation for gestational age, regional rates of active antenatal care varied between 22% (95% CI 5% to 38%) and 61% (95% CI 44% to 78%). Despite adjustment for individual and organisational characteristics, active antenatal care varied significantly between maternity units (p=0.03). Rates of active antenatal care increased with gestational age with an aOR of 6.46 (95% CI 3.40 to 12.27) and 10.09 (95% CI 5.26 to 19.36) for infants born at 25 and 26 weeks' gestation compared with those born at 24 weeks. No other individual characteristic was associated with active antenatal care.


Even after standardisation for gestational age, active antenatal care in France for extremely preterm births varies widely with place of birth. The dependence of life and death decisions on place of birth raises serious ethical questions.


Extreme preterm birth; active antenatal care

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