671 Consequences and barriers of limited access to prenatal care

Abstract

The aims of this study were to: (1) evaluate perinatal outcomes amongst women with and without prenatal care (PNC), and (2) examine different barriers to receiving PNC according to block-level data of residence. We hypothesized that women in low resource areas of an inner-city community would have worse outcomes and more barriers to receiving PNC services. This was a retrospective cohort study of pregnant women delivering at > 24 weeks gestation in a large inner-city public hospital system. Maternal characteristics and perinatal outcomes were examined amongst women with and without PNC. PNC was defined as at least one visit prior to delivery. Barriers to care were analyzed, including public transportation access and location of nearest county-sponsored prenatal clinic according to block-level location of residence. Statistical analysis included chi-square test and analysis of variance (ANOVA) with logistic regression performed for adjustment of demographic features. Between 1 January and 31 October 2019, 9,488 women received PNC whereas 326 did not. Women without PNC differed by race and were noted to have higher rates of substance use (P=.004), higher rates of preterm birth, and longer lengths of newborn admission (both P<.001, Table). After adjustment for demographic features, higher rates of preterm birth in women without PNC persisted (aOR 2.65, 95%CI 1.95-3.55). Women without PNC resided in areas that relied more on public transportation and required longer transit times (42 min vs 30 min, P=.005) with more bus stops (29 vs 17, P<.001) to the nearest county-sponsored PNC clinic (Figure). Women without PNC are at significantly increased risk for adverse pregnancy outcomes. In a large inner-city, women without PNC reside in areas with significantly higher demands for public transportation. Alternative resources, including telemedicine and ride-sharing, should be explored to reduce barriers to care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)