title: Perinatal regionalization: a geospatial view of perinatal critical care, United States, 2010-2013.
abstract: BACKGROUND
  Perinatal services exist today as a dyad of maternal and neonatal care. When perinatal care is fragmented or unavailable, excess morbidity and mortality may occur in pregnant women and newborns.
  
  
  OBJECTIVE
  The objective of the study was to describe spatial relationships between women of reproductive age, individual perinatal subspecialists (maternal-fetal medicine and neonatology), and obstetric and neonatal critical care facilities in the United States to identify gaps in health care access.
  
  
  METHODS
  We used geographic visualization and conducted surface interpolation, nearest neighbor, and proximity analyses. Source data included 2010 US Census, October 2013 National Provider Index, 2012 American Hospital Association, 2012 National Center for Health Statistics Natality File, and the 2011 American Academy of Pediatrics directory.
  
  
  RESULTS
  In October 2013, there were 2.5 neonatologists for every maternal-fetal medicine specialist in the United States. In 2012 there were 1.4 level III or higher neonatal intensive care units for every level III obstetric unit (hereafter, obstetric critical care unit). Nationally, 87% of women of reproductive age live within 50 miles of both an obstetric critical care unit and a neonatal intensive care unit. However, 18% of obstetric critical care units had no neonatal intensive care unit, and 20% of neonatal intensive care units had no obstetric critical care unit within a 10 mile radius. Additionally, 26% of obstetric critical care units had no maternal-fetal medicine specialist practicing within 10 miles of the facility, and 4% of neonatal intensive care units had no neonatologist practicing within 10 miles.
  
  
  CONCLUSIONS
  Gaps in access and discordance between the availability of level III or higher obstetric and neonatal care may affect the delivery of risk-appropriate care for high-risk maternal fetal dyads. Further study is needed to understand the importance of these gaps and discordance on maternal and neonatal outcomes.
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Mary D
authors: MD
authors: Brantley
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Nicole L
authors: NL
authors: Davis
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: igc4@cdc.gov.
authors: David A
authors: DA
authors: Goodman
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: William M
authors: WM
authors: Callaghan
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Wanda D
authors: WD
authors: Barfield
mesh_terms: D003422:Critical Care; D005260:Female; D062305:Geographic Mapping; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D009359:Neonatology; D009774:Obstetrics; D018743:Perinatal Care; D010500:Perinatology; D011247:Pregnancy; D062206:Spatial Analysis; D014481:United States
keywords: critical care; geospatial; neonatal; obstetric; perinatal