Geographic barriers to prenatal care access and their consequences

Holcomb, Denisse S.; Pengetnze, Yolande; Steele, Ashley; Karam, Albert; Spong, Catherine Y.; Nelson, David B.

doi:10.1016/j.ajogmf.2021.100442

Cited by 33 publications

(27 citation statements)

References 34 publications

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“…Our findings echo those of other studies with different populations in the U.S. that have recognized transportation difficulties as a central barrier to healthcare utilization ( 77 , 78 ) in general and SRH services utilization in particular ( 79 – 82 ). In our study, only one clinic was able to offer transportation aid to refugee women.…”

Section: Discussionsupporting

confidence: 88%

System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers’ perspectives

Besera

et al. 2022

Front. Glob. Womens Health

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Refugee women have poor outcomes and low utilization of sexual and reproductive health (SRH) services, which may be driven by access to and quality of SRH services at their resettled destinations. While healthcare providers offer valuable insights into these topics, little research has explored United States (U.S.) providers' experiences. To fill this literature gap, we investigate U.S. providers' perspectives of healthcare system-related factors influencing refugee women's access and utilization of SRH services. Between July and December 2019, we conducted in-depth, semi-structured interviews with 17 providers serving refugee women in metropolitan Atlanta in the state of Georgia (United States). We used convenience and snowball sampling for recruitment. We inquired about system-related resources, facilitators, and barriers influencing SRH services access and utilization. Two coders analyzed the data using a qualitative thematic approach. We found that transportation availability was crucial to refugee women's SRH services access. Providers noted a tension between refugee women's preferred usage of informal interpretation assistance (e.g., family and friends) and healthcare providers’ desire for more formal interpretation services. Providers reported a lack of funding and human resources to offer comprehensive SRH services as well as several challenges with using a referral system for women to get SRH care in other systems. Culturally and linguistically-concordant patient navigators were successful at helping refugee women navigate the healthcare system and addressing language barriers. We discussed implications for future research and practice to improve refugee women's SRH care access and utilization. In particular, our findings underscore multilevel constraints of clinics providing SRH care to refugee women and highlight the importance of transportation services and acceptable interpretation services. While understudied, the use of patient navigators holds potential for increasing refugee women's SRH care access and utilization. Patient navigation can both effectively address language-related challenges for refugee women and help them navigate the healthcare system for SRH. Future research should explore organizational and external factors that can facilitate or hinder the implementation of patient navigators for refugee women's SRH care.

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Section: Discussionsupporting

confidence: 88%

System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers’ perspectives

Besera

et al. 2022

Front. Glob. Womens Health

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“…The mechanism by which area deprivation affects neonatal outcomes may include the effect of maternal adversity on the developing fetus 33,34 . Maternal stress and poor access to prenatal care have been linked with adverse birth outcomes [35][36][37] . Lower maternal socioeconomic status increases the risk of preterm birth 11,38,39 and among those born prematurely, it increases the risk of adverse neurodevelopmental outcomes 40,41 .…”

Section: Discussionmentioning

confidence: 99%

“…Black vs. White* 77 [45,93] 57 [32,77] Female vs. Male 68 [38,87] 64 [37,86] Inborn vs. Outborn* 63 [35,86] 53 [29,76] Sepsis or NEC vs. neither* 68 [41,88] 64 [35,86] Severe IVH vs. mild/no IVH* 69 [44,90] 64 [36,86]…”

Section: Discussionmentioning

confidence: 99%

Neighborhood deprivation is associated with NICU mortality for extremely premature infants: A 4-NICU study

Sullivan

Doshi

Chernyavskiy

et al. 2022

Preprint

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Importance: Socioeconomic status impacts pregnancy outcomes and child development after NICU discharge for infants born prematurely, but has not been well studied for outcomes during the NICU stay. The Area Deprivation Index (ADI) is a validated measure of neighborhood disadvantage that uses Census data on income, education, employment, and housing quality. Objective: In NICUs in different US regions, determine if ADI predicts NICU mortality and morbidity in extremely premature infants. Design: We conducted a retrospective cohort study. Setting: Four level IV neonatal intensive care units (NICU) in different US geographic regions: Northeast, Mid-Atlantic, Midwest, and South. Participants: Non-Hispanic White and Black extremely premature infants (gestational age <29 weeks) and admitted to a study NICU from 2012-2020. Exposures: ADI, race, BW, sex, and outborn status (admitted after transfer from an outside birth hospital). Main Outcomes and Measures: We converted addresses to census blocks, identified by 12-digit Federal Information Processing Series (FIPS) codes, to link residences to the national ADI percentile of study participants. We analyzed the relationship between ADI and NICU mortality using Bayesian logistic regression adjusted for race, BW, outborn status, and sex. Predictors were considered significant if the 95% Credible Intervals excluded zero. We also analyzed the effect of ADI on NICU morbidities of late-onset sepsis, necrotizing enterocolitis, and severe intraventricular hemorrhage. Results: We studied 2,765 infants. In univariate analysis, infants with higher ADI were more likely to be Black, suffer from short-term morbidities, and die before NICU discharge. ADI did not correlate with BW (r = -0.05) or sex. Black infants also had higher mortality and lower BW. In a multivariable model, lower BW, higher ADI, and male sex were statistically significant risk factors, while Black race and outborn status were not. Using these methods, ADI was also identified as a risk factor for NICU morbidities. Conclusions and Relevance: Among extremely preterm infants admitted to four NICUs in different US geographic regions, ADI was a risk factor for mortality and morbidity after adjusting for multiple covariates. These findings have implications for public health measures to improve prenatal and NICU care for patients from disadvantaged areas.

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“…Parkland Health serves underresourced patients of Dallas County and has developed a neighborhood-based, administratively and medically integrated public health care system for innercity pregnant patients. 10,11 All patients are assigned to a neighborhood clinic for antenatal care. On enrollment into prenatal care, patients with a history of PTB are referred to a dedicated clinic centrally located at Parkland Hospital.…”

Section: Methodsmentioning

confidence: 99%

“…Despite medication nonadherence, the frequency of completed patient visits for those in the VP cohort was significantly greater than those with other high-risk pregnancy conditions (median number of visits, 13 [IQR,[10][11][12][13][14][15][16] vs 11 [IQR, 8-13]; P < .001) (eFigure 3 in the Supplement). Selected Demographic and Clinical Characteristics of Study Cohort With 3:1 Matched Historical Controls…”

mentioning

confidence: 99%

Association of Vaginal Progesterone Treatment With Prevention of Recurrent Preterm Birth

et al. 2022

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ImportancePreterm birth (PTB) is the leading cause of infant morbidity and mortality worldwide. It has been suggested that vaginal progesterone (VP) treatment may reduce the recurrence of PTB.ObjectiveTo evaluate the association of VP treatment with prevention of recurrent PTB among patients with a singleton pregnancy.Design, Setting, and ParticipantsThis prospective, observational cohort study, set in a public health care system for inner-city pregnant patients, enrolled patients with prior spontaneous PTB (gestational age, ≤35 weeks) receiving VP from May 15, 2017, to May 7, 2019. Patients who delivered between 1998 and 2011 served as a referent cohort matched 3:1 for obesity, race and ethnicity, and individual specific preterm birth history. Statistical analysis was performed from August 19, 2021, to September 2, 2022.ExposurePatients received 90 mg of vaginal progesterone, 8%, nightly, initiated between 16 weeks and 0 days and 20 weeks and 6 days of pregnancy until 36 weeks and 6 days of pregnancy or delivery.Main Outcomes and MeasuresThe primary outcome was overall rate of recurrent PTB at 35 weeks or less of patients given VP compared with the 3:1 matched untreated historical controls. Secondary outcomes included assessment of PTB according to adherence (≥80% completing scheduled doses), duration of pregnancy relative to index gestational age, progesterone blood levels, and outcomes for those who declined VP.ResultsA total of 417 patients (mean [SD] age, 30.4 [5.9] years; 64 Black patients [15.3%]; 272 [65.2%] with a body mass index of ≥30) received VP and were matched with 1251 controls (mean [SD] age, 28.8 [5.7] years; 192 Black patients [15.3%]; 816 [65.2%] with a body mass index of ≥30). The overall rate of recurrent PTB was 24.0% (100 of 417; 95% CI, 20.0%-28.4%) for the VP cohort compared with 16.8% (1394 of 8278) expected in the matched historical controls. Adherence was not associated with lower rates of recurrent PTB compared with nonadherence (odds ratio, 0.87 [95% CI, 0.51-1.41]). The mean difference between historical matched controls and those using VP was 0.2 weeks (95% CI, −1.4 to 1.0 weeks) without improvement in the interval of recurrent PTB after the implementation of VP (P = .73). Progesterone blood levels for patients who were adherent compared with those who were nonadherent were not significantly different at either 24 or 32 weeks (24 weeks: 99 ng/mL [95% CI, 85-121 ng/mL] vs 104 ng/mL [95% CI, 89-125 ng/mL]; P = .16; 32 weeks: 200 ng/mL [95% CI, 171-242 ng/mL] vs 196 ng/mL [95% CI, 155-271 ng/mL]; P = .69).Conclusions and RelevanceThis cohort study of patients with a current singleton pregnancy suggests that VP was not associated with a reduction in recurrent PTB.

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Geographic barriers to prenatal care access and their consequences

Cited by 33 publications

References 34 publications

System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers’ perspectives

System-level factors influencing refugee women's access and utilization of sexual and reproductive health services: A qualitative study of providers’ perspectives

Neighborhood deprivation is associated with NICU mortality for extremely premature infants: A 4-NICU study

Association of Vaginal Progesterone Treatment With Prevention of Recurrent Preterm Birth

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