Mother's ZIP Code, Lack of Access to Prenatal Care Can Negatively Impact Baby's Health at Birth, New Studies Show

SAN ANTONIO - Babies born to mothers who live in rural areas or who don't receive prenatal care may face higher risks of health complications at birth, suggests research presented at the ANESTHESIOLOGY^® 2025 annual meeting .

"Recent closures of medical centers in rural Georgia and other rural areas around the country have created health care deserts that may impact the care of mothers and their newborns," said Bibiana Avella Molano, M.D., lead author of the study and a third-year anesthesiology resident at Augusta University, Georgia. "Our research highlights how limited access to health care in underserved areas can affect newborn health and reinforces that both individual patient factors and geographic inequities need to be addressed through targeted interventions."

The researchers conducted two studies to examine independent variables that may impact Apgar results, a quick test, scored on a scale from 0-10, taken one and five minutes after birth to assess the baby's health and determine whether they need immediate medical care. Scores of 6 or lower are considered "non-reassuring" and signify the baby may need to be monitored or receive extra care, such as oxygen, assistance with breathing or help keeping their heart beating.

For both studies, researchers reviewed the one-minute Apgar scores of infants delivered to 2,952 women at one health center in Georgia between November 2018 and October 2023.

In the first study, the authors used color-coded maps tied to patients' ZIP codes to visually highlight how health outcomes differ across geographic areas, assessing various disparities between urban and rural areas. They determined that women from rural areas had fewer prenatal care visits and were more likely to deliver their babies early (before 37 weeks of pregnancy). Of the 442 women from rural areas, 108 had infants with non-reassuring Apgar scores (24%), while 502 of the 2,510 women from urban areas had infants with non-reassuring Apgar scores (20%), a significant difference. Overall, babies born to women from rural areas were 30% more likely to deliver infants with non-reassuring Apgar scores compared to women from urban areas.

In the second study, the researchers determined that 214 of the 2,952 women studied had received no prenatal care before delivery and were 2.6 times more likely to have infants with non-reassuring Apgar scores, compared to 2,738 women who had prenatal care. They also determined that vaginal deliveries and births closer to full term had better Apgar scores.

The American College of Obstetricians and Gynecologists (ACOG) and Centers for Disease Control and Prevention (CDC) recommend that women visit their health care professional when they are eight-12 weeks pregnant, then every four weeks until 28 weeks pregnant, and then weekly until they deliver.

"Where a mother lives shouldn't determine whether her baby starts life healthy," said Mary Arthur, M.D., MPH, professor and anesthesiology residency program director at Augusta University. "Yet our research shows that rural mothers face real disadvantages, including limited prenatal care, which can increase the chance of complications at birth."

The researchers say the findings highlight a need for interventions to address systemic inequities. For example, community outreach programs can help identify and support pregnant women facing barriers to care, such as a lack of transportation, economic constraints or limited education. Health care professionals should also identify mothers with risk factors such as higher body mass index or likely cesarean delivery, as they may be more likely to deliver babies with health complications. For these high-risk pregnancies, involving the anesthesia team early helps ensure the mother is as healthy as possible and prepares the team for an emergency birth.

"Prenatal care is one of the most powerful tools we have to improve newborn health," said Dr. Avella Molano. "These findings highlight the importance of making sure all mothers, especially those in underserved areas, can access consistent prenatal services."

*** ANESTHESIOLOGY 2025 news releases may contain updated data that was not originally available at the time abstracts were submitted.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 59,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org . To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment . Join the #ANES25 conversation on social media. Follow ASA on Facebook , X , Instagram , Bluesky and LinkedIn .

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