BACKGROUND
Although prenatal care has long been viewed as an important strategy toward improving
maternal morbidity and mortality, limited data exist that support the premise that
access to prenatal care impacts perinatal outcomes. Furthermore, little is known about
geographic barriers that impact access to care in an underserved population and how
this may influence perinatal outcomes.
OBJECTIVE
This study aimed to (1) evaluate perinatal outcomes among women with and without prenatal
care and (2) examine barriers to receiving prenatal care according to block-level
data of residence. We hypothesized that women without prenatal care would have worse
outcomes and more barriers to receiving prenatal care services.
STUDY DESIGN
This was a retrospective cohort study of pregnant women delivering at ≥24 weeks’ gestation
in a large inner-city public hospital system. Maternal and neonatal data were abstracted
from the electronic health record and a community-wide data initiative data set, which
included socioeconomic and local geographic data from diverse sources. Maternal characteristics
and perinatal outcomes were examined among women with and without prenatal care. Prenatal
care was defined as at least 1 visit before delivery. Outcomes of interest were (1)
preterm delivery at <37 weeks’ gestation, (2) preeclampsia or eclampsia, and (3) days
in the neonatal intensive care unit after delivery. Barriers to care were analyzed,
including public transportation access and location of the nearest county-sponsored
prenatal clinic according to block-level location of residence. Statistical analysis
included chi-square test and analysis of variance with logistic regression performed
for adjustment of demographic features.
RESULTS
Between January 1, 2019, and October 31, 2019, 9488 women received prenatal care and
326 women did not. Women without prenatal care differed by race and were noted to
have higher rates of substance use (P=.004), preterm birth (P<.001), and longer lengths of newborn admission (P<.001). After adjustment for demographic features, higher rates of preterm birth in
women without prenatal care persisted (adjusted odds ratio, 2.65; 95% confidence interval,
1.95–3.55). Women without prenatal care resided in areas that relied more on public
transportation and required longer transit times (42 minutes vs 30 minutes; P=.005) with more bus stops (29 vs 17; P<.001) to the nearest county-sponsored prenatal clinic.
CONCLUSION
Women without prenatal care were at a significantly increased risk of adverse pregnancy
outcomes. In a large inner city, women without prenatal care resided in areas with
significantly higher demands for public transportation. Alternative resources, including
telemedicine and ridesharing, should be explored to reduce barriers to prenatal care
access.
Key words
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Article info
Publication history
Published online: July 07, 2021
Accepted:
July 1,
2021
Received:
June 14,
2021
Footnotes
The authors report no conflict of interest.
The study did not receive any financial support.
The abstract of this study was presented at the 41st annual meeting of the Society for Maternal-Fetal Medicine, held virtually, January 25–30, 2021.
Cite this article as: Holcomb DS, Pengetnze Y, Steele A, et al. Geographic barriers to prenatal care access and their consequences. Am J Obstet Gynecol MFM 2021;XX:x.ex–x.ex.
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