Rural Women in the United States Burdened by High Maternal Transfer Rates [28C

Abstract

INTRODUCTION: To describe obstetrical transfer patterns concerning maternal characteristics and outcomes. METHODS: Using 2014–2016 birth records from the National Center for Health Statistics (NCHS) we examined antepartum transfer based on maternal resident county: large metropolitan center (LMC), large metropolitan fringe (LMF), medium metropolitan (M metro), small metropolitan (S metro), micropolitan (Micro) and non-core/rural (Non-core). We examined the association between transfer and sociodemographic, health, and peripartum characteristics. RESULTS: 59,399 transfers occurred among 11,233,882 hospital births (0.53%). More were living in Micro (OR 3.68, CI 3.59–3.77) and Non-core counties (OR 5.05, CI 4.92–5.19), <18 (OR 1.40, CI 1.33–1.48), non-Hispanic American Indian/Alaskan Native (NH-AIAN) (OR 8.31, CI 8.06–8.56), without prenatal care (OR 4.29, CI 4.14–4.45) and Medicaid (OR 1.47, CI 1.44–1.49) or self-pay (OR 1.67, CI 1.60–1.74). Associated characteristics included smoking (OR 2.40, CI 2.35–2.46), BMI >40 (OR 1.77, CI 1.71–1.83), diabetes (OR 1.63, CI 1.59–1.67), hypertension (OR 3.67, CI 3.59–3.75), multiparity (OR 4.98, CI 4.87–5.10), breech (OR 3.84, CI 3.77–3.93), chorioamnionitis (OR 2.42, CI 2.32–2.53), cesarean (OR 2.04, CI 2.00–2.07) and preterm (OR 21.5, CI 21.1–21.9). Morbidity was high with increased blood transfusion (OR 5.21, CI 4.87–5.58), ICU admission (OR 9.64, CI 8.98–10.36), uterine rupture (OR 3.93, CI 3.07–5.02) and hysterectomy (OR 7.08, CI 4.87–5.57). CONCLUSION: Transport disproportionately affects rural women. These moms are more likely rural, younger, NH-AIAN, without prenatal care, and utilize Medicaid or self-pay. Numerous individual and health systems factors led to increased morbidity for mothers and infants suggesting areas for future quality initiatives.