Abstract
Background: Disasters are associated with worse perinatal outcomes, perhaps due to inadequate prenatal care (PNC). Methods: Using 2017–2019 Florida vital statistics, we compared PNC use before and after Hurricane Michael. We categorized counties as most affected (Area A) or less affected (Area B and C). We examined whether Michael’s effects on perinatal outcomes varied by maternity care availability and used the Baron and Kenny method to assess whether delayed PNC initiation mediated perinatal outcomes. Log-binomial regression and semi-parametric linear regression were used, controlling for maternal and ZIP code tabulation area characteristics. Results: Compared to the one-year period pre-Michael, the week of the first PNC was later in all areas in the one-year period post-Michael, with the largest change in Area A (adjusted difference 0.112, 95% CI: 0.055–0.169), where women were less likely to receive PNC overall (aRR = 0.994, 95% CI = 0.990–0.998) and more likely to have inadequate PNC (aRR = 1.193, 95% CI = 1.127–1.264). Michael’s effects on perinatal outcomes did not vary significantly by maternity care availability within Area A. Delayed PNC initiation appeared to mediate an increased risk in small for gestational age (SGA) births after Michael. Conclusion: Women in Area A initiated PNC later and had a higher likelihood of inadequate PNC. Delayed PNC initiation may partially explain increased risk of SGA.
Highlights
IntroductionDisaster can produce temporary or permanent “maternity care deserts”, as the March of Dimes terms areas with no delivery or prenatal care [1]
Adjusting for prenatal care (PNC) initiation did not change the association between the hurricane and small for gestational age (SGA) substantially, we identified positive associations between the hurricane and SGA, the hurricane and delayed PNC
We found evidence that PNC was disrupted by Hurricane Michael, the increase in adverse perinatal outcomes was not explained by delayed PNC initiation overall, which is consistent with previous studies [6,7,12,13,14]
Summary
Disaster can produce temporary or permanent “maternity care deserts”, as the March of Dimes terms areas with no delivery or prenatal care [1]. While health care is clearly necessary for birth emergencies, limited access to obstetric care has been associated with worse birth outcomes and maternal health [2,3,4]. Tend to find an increase in the proportion of women receiving late and often inadequate prenatal care (PNC) [5]. A few studies have found otherwise [6,7,8]. Other studies implicitly or explicitly consider lack of PNC to be one mediator of disaster effects. Zahran et al found an increase in fetal distress after Hurricane Andrew and recommended more and better postdisaster PNC as a mitigating strategy [9]
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