{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:21:59Z","timestamp":1783405319738,"version":"3.54.6"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T00:00:00Z","timestamp":1703635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR002537"],"award-info":[{"award-number":["UL1TR002537"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Our aim was to investigate the roles of rurality and distance to care on adverse perinatal outcomes and COVID\u201019 seroprevalence at the time of delivery over a 1\u2010year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were collected from the electronic medical record on all pregnant patients who delivered at a single, large, Midwest academic medical center over 1 year. Rurality was classified using standard Rural\u2010Urban Commuting Area codes. Geographic Information System tools were used to map outcomes. Data were analyzed with univariate and multivariate models, controlling for Body Mass Index (BMI), insurance status, and parity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>A total of 2,497 patients delivered during the study period; 20% of patients were rural (n = 499), 18.6% were micropolitan (n = 466), and 61.4% were metropolitan (n = 1,532). 10.4% of patients (n = 259) were COVID\u201019 seropositive. Rural patients did not experience higher rates of any measured adverse outcomes than metropolitan patients; micropolitan patients had increased odds of preterm labor (OR = 1.41, <jats:italic>P<\/jats:italic> = .022) and pre\u2010eclampsia (OR = 1.78, <jats:italic>P<\/jats:italic>&lt;.001). Patients living 30+ miles away from the medical center had increased odds of preterm labor (OR = 1.94, <jats:italic>P<\/jats:italic>&lt;.001), pre\u2010eclampsia (OR = 1.73, <jats:italic>P<\/jats:italic> = .002), and infant admission to the neonatal intensive care unit (OR = 2.12, <jats:italic>P<\/jats:italic>&lt;.001), as well as lower gestational age at delivery (\u03b2 = \u22129.2 days, <jats:italic>P<\/jats:italic>&lt;.001) and birth weight (\u03b2 = \u2212206 grams, <jats:italic>P<\/jats:italic>&lt;.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Distance to care, rather than rurality, was the key predictor of multiple adverse perinatal outcomes in this cohort of deliveries over a 1\u2010year period. Our study suggests that rurality should not be used as a standalone indicator of access to care without further knowledge of the specific barriers affecting a given population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12820","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T03:58:38Z","timestamp":1703735918000},"page":"520-530","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effects of rurality and distance to care on perinatal outcomes over a 1\u2010year period during the COVID\u201019 pandemic"],"prefix":"10.1111","volume":"40","author":[{"given":"Pratyusha V.","family":"Bujimalla","sequence":"first","affiliation":[{"name":"University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2324-8266","authenticated-orcid":false,"given":"Kimberly A.","family":"Kenne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley A.","family":"Steffen","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha R.","family":"Swartz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linder H.","family":"Wendt","sequence":"additional","affiliation":[{"name":"Institute of Clinical and Translational Science University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam M.","family":"Skibbe","sequence":"additional","affiliation":[{"name":"Department of Geographical and Sustainability Sciences University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Brooks","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7657-5746","authenticated-orcid":false,"given":"Mary B.","family":"Rysavy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Iowa  Iowa City Iowa USA"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2019.100398"},{"issue":"6","key":"e_1_2_8_3_1","article-title":"The burden of obesity in the rural adult population of America","volume":"13","author":"Okobi OE","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12689"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-6306"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100042\u20101749666"},{"key":"e_1_2_8_7_1","unstructured":"Iowa Quick Facts. 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