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Travel Time to Delivery, Antenatal Care, and Birth Outcomes: A Population-Based Cohort of Uncomplicated Pregnancies in British Columbia, 2012–2019

      Abstract

      Objective

      Health policy and system leaders need to know whether long travel time to a delivery facility adversely affects birth outcomes. In this study, we estimated associations between travel time to delivery and outcomes in low-risk pregnancies.

      Methods

      This population-based cohort included all singleton births without obstetric comorbidities or intrapartum facility transfers in British Columbia, Canada, from 2012 to 2019. Travel time was measured from maternal residential postal code to delivery facility using road network analysis. We estimated associations between travel time and severe maternal morbidity, stillbirth, pre-term birth, and small-for-gestational age (SGA) and large-for-gestational age (LGA) status using logistic regression, adjusted for confounders (adjusted odds ratios [aORs]). To examine variations in associations between travel time and outcomes by antenatal care utilization, we stratified models by antenatal care categories.

      Results

      Of 232 698 births, 3.8% occurred at a facility ≥60 minutes from the maternal residence. Obesity, adolescent age, substance use, inadequate prenatal care, and low socioeconomic status were more frequent among those traveling farther for delivery. Travel time ≥120 minutes was associated with increased risk of stillbirth (aOR 1.8; 95% CI 1.2–2.8), pre-term birth (aOR 2.3; 95% CI 2.1–2.5), LGA (aOR 1.5; 95% CI 1.4–1.6), and severe maternal morbidity (aOR 1.5; 95% CI 1.2–1.8), but not SGA (aOR 1.0; 95% CI 0.8–1.1), when compared with a travel time of 1–29 minutes. Risk of stillbirth was greatest with inadequate and intensive (adequate plus) antenatal care but persisted for severe maternal morbidity, pre-term birth, and LGA across categories.

      Conclusion

      Longer travel time to delivery was associated with increased risk of adverse outcomes in low-risk pregnancies after adjusting for confounding factors. Associations were stronger among those with inadequate antenatal care.

      Résumé

      Objectif

      Les responsables des politiques sanitaires et des systèmes de santé doivent savoir si un long trajet vers un centre d’accouchement nuit à l’issue de l’accouchement. Dans cette étude, nous avons estimé l’association entre la durée du trajet vers un centre d’accouchement et les issues en contexte de grossesse à faible risque.

      Méthodologie

      Cette cohorte populationnelle comprend tous les accouchements de grossesse monofœtale sans comorbidité obstétricale ni transfert per partum ayant eu lieu en Colombie-Britannique (Canada) pour la période de 2012 à 2019. La durée du trajet a été calculée en évaluant par analyse du réseau routier l’éloignement du centre d’accouchement à partir du code postal résidentiel de la mère. Nous avons estimé l’association entre la durée du trajet et la morbidité maternelle grave, la mortinaissance, l’accouchement prématuré et le statut d’hypo- ou d’hypertrophie néonatale à l’aide d’une régression logistique avec ajustement pour tenir compte des facteurs de confusion (rapports de cotes ajustés [RCa]). Pour examiner la variation de l’association entre la durée du trajet et les différentes issues selon le niveau d’utilisation des soins prénataux, nous avons stratifié les modèles par catégories de soins prénataux.

      Résultats

      Des 232 698 accouchements, 3,8 % ont eu lieu dans un établissement à ≥ 60 minutes de la résidence maternelle. L’obésité, la grossesse adolescente, la consommation de substances psychoactives, les soins prénataux inadéquats et le faible statut socioéconomique étaient plus fréquents chez les personnes ayant un long trajet vers le centre d’accouchement. Une durée de trajet de ≥ 120 minutes a été associée à une augmentation du risque de mortinaissance (RCa : 1,8; IC à 95 % : 1,2–2,8), d’accouchement prématuré (RCa : 2,3; IC à 95 % : 2,1–2,5), d’hypertrophie néonatale (RCa : 1,5; IC à 95 % : 1,4–1,6) et de morbidité maternelle grave (RCa : 1,5; IC à 95 % : 1,2–1,8), mais pas d’hypotrophie néonatale (RCa : 1,0; IC à 95 % : 0,8–1,1), comparativement à une durée de trajet de 1 à 29 minutes. Le risque de mortinaissance s’est avéré le plus élevé dans les cas de soins prénataux inadéquats ou intensifs (adéquats plus), et le risque s’est révélé persistant pour la morbidité maternelle grave, l’accouchement prématuré et l’hypertrophie néonatale dans toutes les catégories.

      Conclusion

      Un long trajet vers le centre d’accouchement est associé à une augmentation du risque d’issue défavorable pour une grossesse à faible risque après ajustement pour tenir compte des facteurs de confusion. L’association est la plus forte dans les cas de soins prénataux inadéquats.

      Keywords

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