title: Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe.
abstract: Survival and quality of life are improved for very preterm babies when delivery occurs in a maternity unit with on-site neonatal intensive care (level III unit). We investigated the impact of distance on the probability of delivering in such a unit for births before 32 weeks of gestation from 9 European regions with diverse perinatal health systems (the MOSAIC cohort). We analysed distances between women's homes, and the nearest level III in population quartiles, adjusting for maternal and pregnancy characteristics. Living farther away from a level III reduced access to specialised care everywhere; in some regions women residing in the fourth quartile were half as likely to deliver in level III units as those in the first. To improve regionalized perinatal care the spatial location of level III units should be taken into account.
authors.affiliation: INSERM, UMR S953, IFR 69, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France. hugo.pilkington@inserm.fr
authors.forename: Hugo
authors.initials: H
authors.lastname: Pilkington
authors.forename: Béatrice
authors.initials: B
authors.lastname: Blondel
authors.forename: Emile
authors.initials: E
authors.lastname: Papiernik
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
authors.forename: Hélène
authors.initials: H
authors.lastname: Charreire
authors.forename: Rolf F
authors.initials: RF
authors.lastname: Maier
authors.forename: Stavros
authors.initials: S
authors.lastname: Petrou
authors.forename: Evelyne
authors.initials: E
authors.lastname: Combier
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Künzel
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D005060:Europe; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008427:Maternal Health Services / Q000600:supply & distribution*; D015999:Multivariate Analysis; D018743:Perinatal Care / Q000458:organization & administration*; D011247:Pregnancy; D047928:Premature Birth