Abstract
Objective
Examine for association between geographic disparity in the national maternal-fetal
medicine (MFM) physician workforce distribution and preterm birth (PTB) rate in counties
without MFM presence.
Study Design
Cohort study of PTBs in the United States from 2015 to 2019, utilizing National Center
for Health Statistics natality data. The independent risk factor is the presence of
an MFM physician in the county or county equivalent where the pregnant woman resides.
Bivariate logistic regression analysis estimated the odds of county-level PTB rates
higher than the national average (10.2%, March of Dimes 2019 national data) by MFM
physician location.
Results
The Northeast, Southeast, and Pacific Coast regions of the United States had the highest
density of physician practice locations whereas regions in the Midwest and Western
United States had the lowest density. Of the 2,981 counties with PTB rates available,
90.3% (n = 2,691) did not have a practicing MFM physician. U.S. counties without an MFM physician
are more likely to have a PTB rate higher than the national average, operating room
(OR) = 1.56 (95% confidence interval [CI], 1.22–1.99), compared with a county with
at least one MFM physician.
Conclusion
Counties with no practicing MFM physician had a 56% increase in the odds of having
PTB rates higher than the national average. The lack of proximate high-risk obstetric
care is a geographic health disparity associated with PTB. The location of the MFM
workforce has implications for both clinical care and health policy. These data suggest
that attention should be directed toward where physicians practice and to increase
access to care for at-risk pregnant women.
Key Points
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U.S. regions with the highest concentration of MFM physicians remain unchanged from
prior publications.
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Only 9.7% of counties reporting PTB data have practicing MFM physicians.
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Counties without an MFM physician have 56% higher odds of exceeding national PTB rates.
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Regional disparities in MFM physician distribution may impact maternal and neonatal
outcomes.
Keywords
maternal-fetal medicine - preterm birth - geographic disparity
