Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe.
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.
Pilkington
Hugo
H
INSERM, UMR S953, IFR 69, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France. hugo.pilkington@inserm.fr
Blondel
Béatrice
B
Papiernik
Emile
E
Cuttini
Marina
M
Charreire
Hélène
H
Maier
Rolf F
RF
Petrou
Stavros
S
Combier
Evelyne
E
Künzel
Wolfgang
W
Bréart
Gérard
G
Zeitlin
Jennifer
J
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