Bold opening: lifesaving antenatal treatments for premature babies are not reaching every mother and baby, and that gap costs lives and futures.
A new global analysis shines a harsh light on how two proven prenatal therapies—the magnesium sulfate (MgSO4) treatment and antenatal corticosteroids (ANS)—are implemented unevenly around the world, even though they dramatically cut the risk of cerebral palsy and respiratory complications in very preterm infants. The Bristol-led study, published in the International Journal of Obstetrics & Gynaecology on February 25, examined neonatal data from more than 300,000 preterm births across ten countries to map how widely these interventions are used in real practice.
Key findings show that babies born before 30 weeks face higher chances of death or serious health problems, including stroke, lung issues, and disabilities like cerebral palsy. MgSO4, given to the mother before a preterm birth, is a cost-effective measure that can significantly lower the likelihood of cerebral palsy in the baby. Antenatal steroids, meanwhile, prepare the baby’s lungs to work more effectively after birth, improving survival odds.
Despite strong international guidelines endorsing both treatments, the study reveals striking disparities in their administration to at-risk mothers. The research team, led by the University of Bristol’s Medical School and NIHR ARC West, analyzed neonatal data for 45,619 preterm infants (24–32 weeks gestation) from 1,111 Vermont Oxford Network (VON) hospitals across ten nations: United Kingdom, Ireland, Austria, Switzerland, Italy, United States, United Arab Emirates, Brazil, South Africa, and India. An additional supplementary review pooled data from ten studies covering 288,631 preterm babies and compared VON findings with English population data from the National Neonatal Research Database.
In MgSO4 use, stark country-by-country differences emerged. Ireland and the UK reported high administration rates (over 80%), while South Africa and the UAE showed much lower uptake (33.6% and 44.5%, respectively). ANS use was more uniform across countries, with less variation observed.
The analysis also uncovered clear income-related disparities. Higher-income countries averaged 74.8% MgSO4 use, compared with 49.4% in middle-income countries. Alarmingly, this equity gap has persisted over time, with supplementary reviews finding treatment rates in line with those seen in the VON cohort.
The authors conclude that global variation in using these two life-saving interventions is substantial, and middle-income countries lag notably behind. They call for more research to uncover the reasons behind these disparities and to strengthen global equity in delivering evidence-based antenatal care.
Hannah Edwards, Senior Research Associate in Medical Statistics at the University of Bristol and ARC West, emphasizes the broader takeaway: international collaboration can drive health equity for mothers and babies. The current picture shows MgSO4 is not equitably available worldwide for cerebral palsy prevention in preterm infants. The PReCePT program offers a blueprint for successfully implementing this medication, and the study suggests adapting such strategies to accelerate routine use across diverse health systems.
As Karen Luyt, PReCePT national clinical lead and Professor of Neonatal Medicine at the University of Bristol, notes, the real challenge isn’t the evidence—it’s turning that evidence into universal practice. The goal is clear: ensure that every baby, wherever born, benefits from treatments proven to give them the best possible start in life.
If you’re curious about the practical implications, consider: what barriers—cost, logistics, training, or policy—prevent you from seeing these life-saving therapies reach all at-risk mothers? Do you think a standardized international implementation framework, similar to PReCePT, could close the equity gap in your country or region? Share your thoughts below.
