Marianne Hillemeier, PhD¹, Carol S. Weisman, PhD², Gary Chase, PhD², and Megan Darnell, MS². (1) Health Policy and Administration, The Pennsylvania State University, 116 Henderson Building, University Park, PA 16802-6500, (814) 863-0873, mmh18@psu.edu, (2) Department of Health Evaluation Sciences, A210, Penn State College of Medicine, 600 Centerview Drive, Suite 2200, Hershey, PA 17033-0855

Objective: To examine predictors of prenatal care use, preterm birth, and low birthweight at the individual and community levels; and to examine the impact of rural-urban maternal residence using measures that capture differences among types of rural communities. Methods: Birth certificate files for 28 central Pennsylvania counties with appended Area Resource File and US Census data were analyzed. Multiple logistic regression analyses were conducted to model the determinants of receipt of first trimester prenatal care, preterm birth (<37 weeks), and low birthweight (<2500 grams). Independent variables included maternal age, education, race/ethnicity, smoking, chronic high blood pressure, and diabetes; county characteristics (percent HS graduates, percent nonwhite, percent below poverty, primary care physicians/100,000); and rural/urban residence using both RUCA codes aggregated into 4 categories and 9-category Urban Influence Codes for counties. Findings: Maternal health was significantly associated with all outcomes. The adjusted odds ratio for chronic hypertension as a predictor of early prenatal care was 1.57 (95% CI 1.06 to 2.34, p=.0258), and the corresponding AOR for low birthweight was 3.50 (95% CI 2.64 to 4.63, p<.0001). County-level characteristics were not uniformly informative, but poverty rate predicted preterm birth, low birthweight, and reduced likelihood of early prenatal care. Results for the two measures of rurality were similar. Urban focused areas had the highest early prenatal care use, while isolated smaller rural areas had the lowest. The pattern of increase was not, however, monotonic with decreasing rurality. Conclusions: Women’s health status is associated with early prenatal care use, and has implications for adverse infant outcomes. Women in isolated small rural areas have the least optimal prenatal care patterns, however the association between decreasing rurality and greater likelihood of early prenatal care is not linear. Access and appropriate utilization of prenatal care among women in isolated small rural areas is of particular concern. Detailed study of the relationships between degree of rurality and medical care use is needed to optimally target intervention activities.

Learning Objectives: At the conclusion of this session, participants will be able to

• Identify important predictors of prenatal care use, preterm birth, and low birthweight
• Describe differences in prenatal care use, preterm birth, and low birthweight among women in various types of rural and urban areas

Keywords: Pregnancy Outcomes, Rural Populations

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.