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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., Objective: Our aim was to identify factors associated with active antenatal care, which is the first step of proactive perinatal care in extremely preterm births., Methods: The population included 1020 singleton births between 22 0/6 and 26 0/6 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., Results: 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., Conclusion: 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., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Because of the important changes in medical care and the social context of pregnancy, the relevance of well-established risk factors of preterm delivery (< 37 weeks) needs to be re-assessed. The objective of this study was to determine whether the associations between maternal characteristics and preterm delivery in France in 1995 were similar to those in 1981. We used two national representative samples of births, 5577 newborns in 1981 and 13318 in 1995. Univariable and multivariable analyses were applied to identify variables associated with increased risk of preterm delivery. Some risk factors were similar in 1981 and 1995, including age > 34 years and previous adverse obstetric history. Other factors that were observed in 1981 but which were not linked to preterm delivery in 1995 included the mothers being very young, single or foreign. However, parity and previous induced abortion were associated with preterm delivery in 1995, but not in 1981. These results show that the definition of high-risk groups used in prevention programmes should be brought up to date regularly. [ABSTRACT FROM AUTHOR]