{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:43:20Z","timestamp":1777859000297,"version":"3.51.4"},"reference-count":49,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"national institutes of health","doi-asserted-by":"publisher","award":["UM1TR004403"],"award-info":[{"award-number":["UM1TR004403"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Obstetrics and Gynecology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA"},{"name":"Department of Family and Community Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA"},{"name":"Hawk-Intellectual and Developmental Disability Research Center","award":["UL1TR002537, UL1TR002537-S1, HD089940, P50HD103556"],"award-info":[{"award-number":["UL1TR002537, UL1TR002537-S1, HD089940, P50HD103556"]}]},{"name":"The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Assess whether maternal rural residence was an independent risk factor (RF) for spontaneous preterm birth (sPTB) at a Midwest tertiary care center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>After excluding deliveries complicated by indications for induced preterm birth, there were 16\u2009974 deliveries among 13\u2009339 women between May 1, 2009, and May 31, 2023. Standard descriptive statistics and Generalized Linear Mixed Models were used to identify RFs for sPTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the 16\u2009974 deliveries, 89.1% were full term, 28.8% were of rural mothers, and the mean maternal age was 29.6\u2009years (y). 15.5% of rural deliveries were sPTBs versus only 9.1% of urban deliveries (P&lt;.001). Significant independent RFs for sPTB included the extremes of maternal age (aOR, 2.14 for age 14 to &lt;20\u2009y and aOR, 3.37 for age \u226540\u2009y) compared to age 20-&lt;30\u2009y, rural vs. urban residence (aOR, 1.56), maternal smoking (aOR, 2.47), transfer from an outside hospital (aOR, 671.3), and female sex of the baby (aOR, 0.79). With the transferred deliveries excluded these factors remained significant with similar aORs and Asian race was an additional significant protective factor (aOR, 0.57). Body mass index, race, ethnicity, type of medical insurance, and primigravidity were not significant RFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Rural residence, extremes of maternal age, maternal smoking, female newborn sex, and transfer from an outside hospital were significant and independent RFs for sPTB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319251357688","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T10:09:44Z","timestamp":1753783784000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Rural Residence an Independent Risk Factor for Spontaneous Preterm Birth at a Midwestern Tertiary Care Center? A Cross-Sectional Study"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6613-164X","authenticated-orcid":false,"given":"Abbie","family":"Lund","sequence":"first","affiliation":[{"name":"The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3315-4116","authenticated-orcid":false,"given":"Barcey T.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA"},{"name":"Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5088-5092","authenticated-orcid":false,"given":"Yinghui","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6697-8026","authenticated-orcid":false,"given":"David A.","family":"Bedell","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3991-8017","authenticated-orcid":false,"given":"Mark K.","family":"Santillan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-023-01727-z"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00878-4"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semperi.2021.151390"},{"key":"e_1_3_3_5_2","volume-title":"2024 March of Dimes Report Card: The State of Maternal and Infant Health for American Families","author":"March of Dimes","year":"2024","unstructured":"March of Dimes. 2024 March of Dimes Report Card: The State of Maternal and Infant Health for American Families. March of Dimes; 2024. Accessed February 11, 2025."},{"key":"e_1_3_3_6_2","unstructured":"Services CfMM. National Health Expenditure Data. 2024. Accessed October 16 2024. https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/national-health-expenditure-data\/historical#:~:text=The%20data%20are%20presented%20by For%20additional%20information%2C%20see%20below"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12864-016-3089-0"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.90943"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1289\/EHP8205"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.3194"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.11.030"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-3400449"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-1878-0204"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.1830"},{"key":"e_1_3_3_16_2","unstructured":"Surgo Ventures. Getting Hyperlocal to Improve Outcomes and Achieve Racial Equity in Maternal Health: The US Maternal Vulnerability Index. Surgo Ventures; 2021. Accessed October 19 2024 https:\/\/surgoventures.org\/resource-library\/getting-hyperlocal-to-improve-outcomes-achieve-racial-equity-in-maternal-health-the-us-mvi"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.15306"},{"key":"e_1_3_3_18_2","unstructured":"Health UoICoP. Research Interest Area: Rural Health. https:\/\/www.public-health.uiowa.edu\/research-interest-area-rural-health\/"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004447"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003243"},{"key":"e_1_3_3_21_2","unstructured":"Economic Research Service USDoA. Rural-Urban Communting Area Codes. Updated September 25 2023. Accessed October 16 2024. https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes\/"},{"key":"e_1_3_3_22_2","unstructured":"Health Resources and Services Administration. How We Define Rural. Updated February 2025. Accessed February 13 2025. https:\/\/www.hrsa.gov\/rural-health\/about-us\/what-is-rural"},{"key":"e_1_3_3_23_2","unstructured":"U.S. Centers for Disease Control and Prevention. Adult BMI Categories. Published March 19 2024. Accessed February 13 2025. https:\/\/www.cdc.gov\/bmi\/adult-calculator\/bmi-categories.html"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12929"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-02940-w"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2006.00066.x"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12668"},{"key":"e_1_3_3_28_2","unstructured":"Iowa HHS Division of Public Health Bureau of Family Health Iowa Hospitals with Obstetric Delivery Services internal tracking 2025."},{"key":"e_1_3_3_29_2","unstructured":"March of Dimes. Where You Live Matters: Maternity Care Access in Iowa. Published 2023. https:\/\/www.marchofdimes.org\/peristats\/reports\/iowa\/maternity-care-deserts"},{"key":"e_1_3_3_30_2","volume-title":"Addressing the Crisis in Rural Maternity Care","author":"Center for Healthcare Quality and Payment Reform","year":"2025","unstructured":"Center for Healthcare Quality and Payment Reform. Addressing the Crisis in Rural Maternity Care. Center for Healthcare Quality and Payment Reform; 2025."},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12758"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12325"},{"issue":"1","key":"e_1_3_3_33_2","first-page":"17","article-title":"Closing rural maternity services: is it worth the risk?","volume":"21","author":"Grzybowski S","year":"2016","unstructured":"Grzybowski S, Kornelsen J, Barclay L. Closing rural maternity services: is it worth the risk? Can J Rural Med. 2016;21(1):17-19.","journal-title":"Can J Rural Med"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms161226209"},{"key":"e_1_3_3_35_2","volume-title":"Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten Access","author":"American Hospital Association","year":"2025","unstructured":"American Hospital Association. Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten Access. American Hospital Association; 2025."},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13288"},{"key":"e_1_3_3_37_2","unstructured":"Health GPCfA. Pesticide Drift Cases in Iowa. 2025. Accessed February 13 2025. https:\/\/uiowa.maps.arcgis.com\/apps\/MapJournal\/index.html?appid=783dbfde24014d1fb8875a376ce7023f"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecoenv.2023.115851"},{"key":"e_1_3_3_39_2","unstructured":"School USGSsWS. Groundwater Decline and Depletion. 2025. Accessed February 13 2025. https:\/\/www.usgs.gov\/special-topics\/water-science-school\/science\/groundwater-decline-and-depletion"},{"key":"e_1_3_3_40_2","unstructured":"Agency USEP. Nitrate and Pesticides in Shallow Ground Water in Agricultural Watersheds. 2022. Accessed February 13 2025. https:\/\/nepis.epa.gov\/Exe\/ZyPURL.cgi?Dockey=P1017VS2.txt"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.ado6638"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmwh.2008.08.009"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.006"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.19365"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfaa149"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.58408"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2021.1900103"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/8367571"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2017.07.005"},{"key":"e_1_3_3_50_2","volume-title":"Access to Care, Outcomes, and Birthing Unit Closures: Results From a Statewide Mixed Methods Study in Iowa","author":"Rouse HL","year":"2022","unstructured":"Rouse HL, Abraham WT, Wallace L, Bruning J, Dorius C. Access to Care, Outcomes, and Birthing Unit Closures: Results From a Statewide Mixed Methods Study in Iowa. Iowa Department of Public Health; 2022."}],"container-title":["Journal of Primary Care &amp; Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319251357688","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21501319251357688","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21501319251357688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:23:22Z","timestamp":1777508602000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21501319251357688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":49,"alternative-id":["10.1177\/21501319251357688"],"URL":"https:\/\/doi.org\/10.1177\/21501319251357688","relation":{},"ISSN":["2150-1319","2150-1327"],"issn-type":[{"value":"2150-1319","type":"print"},{"value":"2150-1327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,29]]},"article-number":"21501319251357688"}}