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CME Credit Offered
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Poster Session 1

(216) The Association between Term Stillbirth and Maternal Care Access at the US County Level

Thursday, January 30, 2025
10:30 AM – 12:30 PM  
Objective: Access to comprehensive maternal care is associated with a reduction in stillbirth rates, yet maternal care access is decreasing across the US. We aim to study the association of maternal care access with stillbirth at term.

Study Design: This is a cross-sectional study using CDC Vital Statistics birth certificate data from 2016-2019. All non-anomalous, singleton births > 37 weeks were included. Maternal care access level was defined by the 2020 March of Dimes Maternal Care Access Report County data using their classification of maternal care access (full, moderate, low, or desert), which is based on proximity to hospitals providing obstetric care, number of obstetric providers per 10,000 births, and percent of uninsured women. The primary outcome was stillbirth at term (> 37 weeks gestational age). Mixed effects multivariable models were used and adjusted for clinical, demographic and county level factors, including access to community resources using the CDC’s Social Vulnerability Index (SVI).

Results: A total of 3,138 counties were included in this analysis with 1,100 (35%) of those counties located in maternity care deserts. Out of 13,304,743 births, term stillbirth occurred in 16,402 deliveries (0.12%); 13% of these stillbirths occurred in counties without full access to maternity care. In mixed effects multivariable models, there were increased odds of stillbirth in maternity care deserts (OR 1.13, 95% CI 1.04-1.22) when compared to full maternity care access. However, this was not statistically significant after adjusting for individual and county level factors (aOR 0.99, 95% CI 0.89-1.09).

Conclusion:

More than a third of US counties are in maternal care deserts and 13% of term stillbirths occur in areas without full access to maternal care. Further studies are needed to identify underlying factors of maternal care access that may contribute to this adverse pregnancy outcome.