(787) Impact of maternity care access on term delivery management following prior demise

To examine whether living in a maternity care desert affects delivery timing and clinical decision-making among term pregnancies complicated by prior fetal or neonatal death.

Study Design:

Retrospective cohort study using 2023 U.S. natality data. We identified 40,109 term births among individuals with a prior child or fetal loss and linked their county of residence to the March of Dimes Maternity Care Access Codes. Multivariable logistic regression adjusted for race, Hispanic ethnicity, public insurance, and advanced maternal age. Outcomes included early term delivery (< 39 weeks), induction of labor(IOL), betamethasone receipt, cesarean delivery (CD), and early term iatrogenic delivery (CD, and IOL).

Results:

Compared to those in full-access counties, individuals in maternity care deserts were more likely to have early term deliveries (40.8% vs 39.5% aOR 1.13; 95% CI: 1.02–1.25; p=0.022). They were not significantly more likely to undergo IOL (28.5% vs 31.8%, p=0.053), receive betamethasone (1.3% vs 2.0%, p=0.668), or CD (35.8% vs 38.8%, p=0.246). Among early term births, iatrogenic delivery rates were similar (64.4% vs 66.0% p=0.46), suggesting non-iatrogenic drivers. Black individuals were more likely to deliver early term than white individuals (44.5% vs 37.7% p< 0.001).

Conclusion:

Despite fewer resources, patients in maternity care deserts received similar rates of obstetric interventions. However, they were more likely to deliver early without corresponding increases in iatrogenic birth, suggesting other contributors. Racial disparities persisted regardless of access level, highlighting that geographic provider availability alone is insufficient to address inequities. Targeted, equity-driven interventions are needed to improve outcomes following prior loss.