{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:38Z","timestamp":1779361658080,"version":"3.51.4"},"reference-count":47,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":44,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Australian J Rural Health"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To summarise administrative and interview data relevant to the care of pregnant people with high BMI in rural British Columbia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this mixed methods analysis, we report administrative health data linked to maternal postal codes, to determine variations in rates of local births across BMI groups (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093247) and to examine associations between BMI and adverse maternal\u2013newborn outcomes (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092527). Qualitative data from 169 healthcare providers and administrators at rural hospitals in BC were analyzed to understand rural providers\u2019 experiences when caring for pregnant women with high BMI. Two clinical guidelines that were developed to improve care for women with obesity are presented, as examples of rural CQI initiatives.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The proportion of local births decreased as BMI increased: 72.7% of those with normal BMI gave birth at rural hospitals compared to 34.9% with a BMI \u2265\u200940. For underweight, overweight, and obese women who gave birth at rural hospitals, the incidence of adverse perinatal outcomes was higher (IRR 1.85; 95% CI: 0.49\u20133.76, IRR\u2009=\u20091.19; 95% CI: 0.74\u20131.80; IRR\u2009=\u20091.81; 95% CI: 0.87\u20133.35), compared to those in the normal BMI range, but the associations were not significant. Healthcare providers also described challenges with maintaining quality and safety when caring for patients with high BMI in a low\u2010volume rural setting and noted that a specialist \u2018cookie cutter\u2019 approach to managing and transferring people with high BMI was not practical in rural communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusion<\/jats:title>\n                    <jats:p>Strategies that improve the care of pregnant women with high BMI must take into account the social risks incurred by birthers and families who leave the community alongside the clinical risks of remaining, with attention also given to the impact of adverse outcomes on health care providers. These processes must be underscored by engagement from regional referral specialists to ensure local providers are clinically supported and that there are efficient transfer pathways to higher levels of care should this be needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajr.70126","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T05:02:06Z","timestamp":1765861326000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u2018I Am Not Going, So You're Doing It\u2019: Management of Pregnant People With High BMI at Rural Hospitals in British Columbia: A Mixed Methods Analysis"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9603-8174","authenticated-orcid":false,"given":"Kathrin","family":"Stoll","sequence":"first","affiliation":[{"name":"Department of Family Practise University of British Columbia  Vancouver British Columbia Canada"},{"name":"Centre for Rural Health Research University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jude","family":"Kornelsen","sequence":"additional","affiliation":[{"name":"Department of Family Practise University of British Columbia  Vancouver British Columbia Canada"},{"name":"Centre for Rural Health Research University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Lin","sequence":"additional","affiliation":[{"name":"Centre for Rural Health Research University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christy","family":"Trafananko","sequence":"additional","affiliation":[{"name":"Golden District Hospital  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Jevitt","sequence":"additional","affiliation":[{"name":"Department of Family Practise University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"e_1_2_20_2_1","unstructured":"World Health Organization (WHO) \u201cObesity and Overweight \u201d(2024) https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/obesity\u2010and\u2010overweight."},{"key":"e_1_2_20_3_1","unstructured":"Perinatal Services BC \u201cPerinatal Health Report: British Columbia 2019\/20 \u201d(2021) http:\/\/www.perinatalservicesbc.ca\/Documents\/Data\u2010Surveillance\/Reports\/PHR\/Perinatal%20Health%20Report%20BC%20201920.pdf."},{"key":"e_1_2_20_4_1","unstructured":"Perinatal Services BC \u201cPerinatal Health Report: British Columbia 2021\/22 \u201d(2023) http:\/\/www.perinatalservicesbc.ca\/Documents\/Data\u2010Surveillance\/Reports\/Perinatal_Health_Report_BC_202122.pdf."},{"key":"e_1_2_20_5_1","doi-asserted-by":"publisher","DOI":"10.1787\/67450d67-en"},{"key":"e_1_2_20_6_1","doi-asserted-by":"publisher","DOI":"10.31083\/j.ceog4908189"},{"key":"e_1_2_20_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000000591"},{"key":"e_1_2_20_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182212006"},{"key":"e_1_2_20_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.12495"},{"key":"e_1_2_20_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.12959"},{"key":"e_1_2_20_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.13035"},{"key":"e_1_2_20_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2018.7531"},{"key":"e_1_2_20_13_1","unstructured":"\u201cDifferences in Obesity Rates Between Rural Communities and Urban Cities in Canada \u201dhttps:\/\/health\u2010infobase.canada.ca\/datalab\/canadian\u2010risk\u2010factor\u2010atlas\u2010obesity\u2010blog.html."},{"issue":"1","key":"e_1_2_20_14_1","first-page":"31","article-title":"Progress Made on Access to Rural Health Care in Canada","volume":"66","author":"Wilson C. 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