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. 2021 Apr 14:13:273-285.
doi: 10.2147/CLEP.S288046. eCollection 2021.

Extremely and Very Preterm Deliveries in a Maternity Unit of Inappropriate Level: Analysis of Socio-Residential Factors

Adrien Roussot  1   2 , Karine Goueslard  1   2 , Jonathan Cottenet  1   2   3   4 , Peter Von Theobald  5 , Patrick Rozenberg  6   7 , Catherine Quantin  1   2   3   4   8
Affiliations

Extremely and Very Preterm Deliveries in a Maternity Unit of Inappropriate Level: Analysis of Socio-Residential Factors

Adrien Roussot et al. Clin Epidemiol. .

Abstract

Purpose: To analyze the socio-residential factors associated with extremely and very preterm deliveries occurring in non-level 3 maternity units in France.

Materials and methods: This is a population-based observational retrospective study using national hospital data from 2012 to 2014. A generalized estimating equations regression model was used to study the characteristics of women who delivered very preterm and the socio-residential risk factors for not delivering in a level 3 maternity unit at 24-31+6d weeks of gestation.

Results: Among deliveries resulting in live births and without contraindication to in-utero transfer, we identified 9198 extremely or very preterm deliveries; 2122 (23.1%) of these were managed in a non-level 3 unit. Our study showed that young maternal age (women under 20 years at delivery) was associated with the risk of giving birth prematurely in a non-level 3 maternity, and particularly in a level 1 maternity unit (adjusted relative risk, 1.53; 95% CI 1.09-2.16). Living more than 30 minutes away from the closest level 3 unit increased the risk of delivering very preterm in a level 1 or 2 unit. Living in an urban area or urban periphery increased the risk of giving birth in a level 2 maternity unit (adjusted relative risk, 1.53; 95% CI 1.28-1.83 and 1.42; 95% CI 1.17-1.71, respectively).

Conclusion: This study shows that young pregnant women living more than 30 minutes from a level 3 hospital have an increased risk of delivering in a maternity unit that is not equipped to deal with premature births. The risk also increases with an urban place of residence when the delivery occurs in a level 2 unit. A clearer understanding of the population at risk of delivering prematurely in a non-level 3 maternity could lead to improvements in structuring healthcare to encourage earlier management and better support.

Keywords: NICU; hospital claims data; maternity level; neonatal intensive care unit; preterm delivery; socio-residential factors.

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Conflict of interest statement

Jonathan Cottenet reports grants from IRESP during the conduct of the study. The authors declared that they have no other potential conflicts of interest for this work.

Figures

Figure 1
Figure 1
Flowchart of the study population.
Figure 2
Figure 2
Travel time to the closest maternity unit by level of maternity unit and type of area.
See this image and copyright information in PMC

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