Racial/ethnic differences exist in patterns of periviable resuscitation, which may reflect underlying differences in patient preference. Alternatively, institutional practices or resources may account for these differences. These findings have important implications for patient care and institutional practice. Our results lay the foundation for additional work to investigate how social, cultural, and institutional factors influence patient-provider decision-making regarding periviable care.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

We found no evidence that the Massachusetts reform was associated with improvements in individual low birthweights or county-level infant mortality rates, despite increasing health insurance coverage rates for adult women of child-bearing age. Because our mortality analysis was ecological, we are not able to draw conclusions about how an individual-level health insurance intervention for uninsured pregnant women would affect the mortality outcomes of their infants.