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

Sabrina Luke; Amy Hobbs; Sunny Mak; Kenny Der; Ann Pederson; Laura Schummers

doi:10.1016/j.jogc.2022.04.009

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

J Obstet Gynaecol Can. 2022 Aug;44(8):886-894. doi: 10.1016/j.jogc.2022.04.009. Epub 2022 May 5.

Authors

Sabrina Luke¹, Amy Hobbs², Sunny Mak³, Kenny Der², Ann Pederson⁴, Laura Schummers⁵

Affiliations

¹ Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC; Women's Health Research Institute, BC Women's Hospital + Health Centre, Provincial Health Services Authority, Vancouver, BC. Electronic address: sabrina.luke@phsa.ca.
² Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC.
³ BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC.
⁴ Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, BC; Women's Hospital + Health Centre, Provincial Health Services Authority, Vancouver, BC.
⁵ Department of Family Practice, University of British Columbia, Vancouver, BC.

PMID: 35525429
DOI: 10.1016/j.jogc.2022.04.009

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.

Keywords: delivery, obstetric; pregnancy outcome; travel.

MeSH terms

Adolescent
British Columbia / epidemiology
Female
Fetal Growth Retardation
Humans
Pregnancy
Pregnancy Complications*
Prenatal Care*
Retrospective Studies
Stillbirth / epidemiology
Weight Gain