PDF herunterladen
Open Access
CC BY 4.0 · Am J Perinatol
DOI: 10.1055/a-2717-3951
Original Article

The Association Between Maternal–Fetal Medicine Physician Density and Pregnancy Outcomes

Authors

  • Tetsuya Kawakita 

    1   EVMS Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States
    2   EVMS Center for Maternal and Child Health Equity and Advocacy, Macon and Joan Brock Virginia Health Sciences at ODU, Norfolk, Virginia, United States

  • Rula Atwani

    1   EVMS Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States

  • Misa Hayasaka

    1   EVMS Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States

  • Lindsay Robbins

    1   EVMS Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States
    2   EVMS Center for Maternal and Child Health Equity and Advocacy, Macon and Joan Brock Virginia Health Sciences at ODU, Norfolk, Virginia, United States

  • George Saade

    1   EVMS Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States
    2   EVMS Center for Maternal and Child Health Equity and Advocacy, Macon and Joan Brock Virginia Health Sciences at ODU, Norfolk, Virginia, United States

Funding Information This work was supported by the Eastern Virginia Medical School (grant numbers: VHS 241231).
Weitere Informationen
Auch verfügbar auf
  Lizenzen und Reprints
Preview

Abstract

Objective

We sought to examine the association between maternal–fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.

Study Design

This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30–59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.

Results

Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9–42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR: 0.70; 95% CI: 0.58–0.85) and pregnancy-related mortality (aIRR: 0.83; 95% CI: 0.71–0.98) compared with states with low MFM density, corresponding to 7.29 (AME: 95% CI: 3.58–11.00) and 5.57 (AME: 95% CI: 0.74–10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared with low MFM density states (aIRR: 1.02; 95% CI: 0.87–1.20).

Conclusion

High MFM-density states have a decreased risk of maternal mortality compared with low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality.

Key Points

  • An association between MFM physician density and maternal mortality is unclear.

  • States with higher MFM density had a lower risk of maternal mortality than those with fewer.

  • This study highlights the importance of increasing MFM access in underserved areas to potentially reduce maternal mortality.

Keywords

maternal death - maternal mortality - physician density - pregnancy-related mortality

Note

This work was presented as an oral presentation at the 45th annual meeting—the pregnancy meeting of the Society for Maternal-Fetal Medicine, January 27 to February 1, 2025.


Supplementary Material



Publikationsverlauf

Eingereicht: 21. Juli 2025

Angenommen: 28. September 2025

Accepted Manuscript online:
08. Oktober 2025

Artikel online veröffentlicht:
16. Oktober 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA