Travel distance to prenatal care and high blood pressure during pregnancy.
OBJECTIVE
To assess whether poor geographic accessibility to prenatal care, as indicated by long distance trips to prenatal care, produced high blood pressure (HPB) during pregnancy.


METHODS
Using the 2007 Los Angeles Mommy and Baby Study for women without hypertension prior to pregnancy (n = 3405), we compared self-reported HBP by travel distance to prenatal care controlling for age, race/ethnicity, marital status, education, household income, weight status, and physical activity.


RESULTS
Results of the multilevel logistic regression shows traveling more than 50 mi to prenatal care is associated with an increased odds for having HPB during pregnancy (odds ratio [OR] = 2.867, 95% confidence interval [CI] = 1.079,7.613), as compared with a travel distance shorter than 5 mi. Traveling 5-14 mi (OR = 0.917, 95% CI = 0.715-1.176), 15-29 mi (OR = 0.955, 95% CI = 0.634-1.438), or 30-50 mi (OR = 1.101, 95% CI = 0.485-2.499) were not significantly associated with more risk of HBP during pregnancy.


CONCLUSIONS
To our knowledge, no previous studies have examined the association between poor geographic accessibility to care and the possible harms of travel burdens for pregnant women. Future research that replicates these findings can assist in developing recommendations for pregnant women and health-care accessibility.
a Department of Public Health Sciences , Clemson University , Clemson , South Carolina , USA.
Lu
L
Shi
b Department of Environmental Health Sciences , UCLA Fielding School of Public Health , Los Angeles , California , USA.
Kara E
KE
MacLeod
c Department of Health Policy and Management, College of Public Health , University of Georgia , Athens , Georgia , USA.
Donglan
D
Zhang
d Department of Obstetrics, The Second Affiliated Hospital , Wenzhou Medical University , Wenzhou , China.
Fan
F
Wang
e Department of Public Health Los Angeles County , Maternal, Child, and Adolescent Health Programs , Los Angeles , California , USA.
Margaret Shin
MS
Chao
D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011295:Prenatal Care; D012959:Socioeconomic Factors; D055815:Young Adult
Gestational hypertension; health services; population health; prenatal care; travel distance