title: Life stressors and barriers to timely prenatal care for women with high-risk pregnancies residing in rural and nonrural areas.
abstract: OBJECTIVE
  To identify the contribution of life stressors and barriers to the untimely initiation of prenatal care for women with high-risk pregnancies living in rural and nonrural areas.
  
  
  METHODS
  Data collected in 10 U.S. states by the 2006-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) were used (n = 34,161). Data were weighted to reflect the PRAMS complex survey design. Separate logistic regression models derived adjusted odds ratios for untimely prenatal care initiation based on several life stressors and barriers.
  
  
  RESULTS
  Women with high-risk pregnancies living in rural areas were more likely to report late initiation of prenatal care (17.5% vs. 14.6%). The most frequently reported life stressors were the same for both cohorts: Moving, having a very sick family member, arguing more than usual with their partners, and having bills they could not pay. The most frequently cited barriers were also the same for both groups: Not having enough money or insurance for health care visits and not being able to get an appointment when they wanted one. Having two or more barriers increased the risk of late prenatal care initiation by 2.85-fold for rural women and 2.01-fold for nonrural women.
  
  
  CONCLUSIONS
  To increase timely prenatal care initiation, preconception interventions are needed that address common life stressors and barriers shared by women living in rural and nonrural areas.
authors: Department of Health Administration and Policy, The College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA. pkitsant@gmu.edu
authors: Panagiota
authors: P
authors: Kitsantas
authors: Kathleen F
authors: KF
authors: Gaffney
authors: Jehanzeb
authors: J
authors: Cheema
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D018566:Pregnancy, High-Risk / Q000523:psychology; D011295:Prenatal Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012111:Residence Characteristics; D018570:Risk Assessment; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult