Oral Concurrent Session 1 - Equity, Public Health, and Policy
Oral Concurrent Sessions
Tetsuya Kawakita, MD, MS
Associate Professor
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, VA, United States
Rula Atwani, MD
Research Fellow
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
.jpg "Lindsay S. Robbins, MD, MPH photo")
Lindsay S. Robbins, MD, MPH
Fellow
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
George R. Saade, MD (he/him/his)
Professor and Chair, Associate Dean for Women's Health Obstetrics and Gynecology
Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
Norfolk, Virginia, United States
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 birth certificate data from 2018 to 2021. The number of MFM physicians per state each year was obtained from the American Medical Association database. The primary exposure was based on the density of MFM per state categorized by quartiles of the ratio of MFM in each state per 100,000 live births (low, fair, moderate, and high). Our primary outcome was maternal mortality rate during pregnancy and up to 42 days postpartum (MMR). Our secondary outcomes were maternal mortality rate up to 365 days postpartum, stillbirth rate, preterm birth rate, and cesarean delivery rate. We calculated incident rate ratios (IRR) with 95% confidence intervals (95%CI) using generalized estimating equations with Poisson distribution and exchange-correlation structure, accounting for confounders.
Results:
The median state MFM density was 31.6 MFM per 100,000 births (interquartile 21.9-42.5). Of 14,803,520 births included in this analysis, 1,683,691 (11.4%) were in low MFM-density states, 5,193,402 (35.1%) births were in fair MFM-density states, 4,557,005 (30.8%) were in moderate MFM-density states, and 3,369,422 (22.8%) were in the high MFM-density states. There was an inverse relationship between the MFM density in the state and its MMR per 100,000 live births (Figure 1). Compared to the low MFM-density states, high MFM-density states were associated with a lower risk of MMR, PRM, and preterm birth (Table 1). There were no significant differences in outcomes between low MFM-density states and fair or moderate MFM-density states except for stillbirths being lower in the moderate MFM-density states compared to the low MFM-density states. High MFM-density states have a decreased risk of maternal mortality compared to low MFM-density states, suggesting an association between MFM physician availability and decreased maternal mortality.
Conclusion:
