Living in a rural or remote area can make advanced obstetric and neonatal care difficult to obtain, potentially increasing the risk of adverse maternal and neonatal outcomes. This study aimed to look at the urban-rural disparity in the trend of cumulative adverse maternal and neonatal outcomes. First, we glanced at the demographic differences between rural and urban mothers. Demographic transitions may have an impact on trends in urban-rural health disparities, as some rural areas have become more isolated as more people move to cities. Several explanations for the urban-rural disparities in adverse birth outcomes have been proposed, including increased smoking prevalence (8), health care disparities (9), and increased exposure to environmental hazards (10). According to our findings, adolescent pregnancy was more common in the rural area (7.6% vs. 5.2%). In general, urban mothers had a higher education than rural mothers, with 19.2% having advanced academic education compared to 12.7% of rural mothers. Rural mothers had slightly lower access to medical insurance and prenatal care facilities, but this was not statistically significant. The prevalence of smoking mothers was nearly identical in both groups. In terms of comorbidities, anemia was more common in rural mothers.
Based on our findings there was no association between adverse maternal outcomes and living residency. A previous study by Lisonkova et al. showed a significant association between rural residence and severe maternal morbidity, in particular, a significant 2-fold increase in the rates of life-threatening conditions such as eclampsia, obstetric embolism, and uterine dehiscence or rupture among women in rural areas (11).
On the other hand, according to our findings, adverse neonatal outcomes were strongly associated with living residency. Rural mothers were at higher risk for preterm birth. This has been previously reported by another study (11). The observed disparities in gestational age at birth by living residency are thought to be related to individual-level socioeconomic status differences. Lower socioeconomic status individuals bear a greater burden of a variety of adverse health outcomes, and there is a consistent social gradient in the risk of preterm birth across various measures of individual-level socioeconomic status including the maternal level of education and income, marital and employment status, and type of health insurance (12). Even after controlling for demographic factors, the link between preterm birth and living residency remained significant. This raises the possibility that other factors such as anemia are influencing the occurrence of preterm birth in rural mothers. Maternal anemia during pregnancy can be considered a risk factor for preterm birth (13).
The other negative neonatal outcome associated with residency was LBW, with rural mothers having twice the risk of having LBW newborns as urban mothers. Part of this may be due to a higher incidence of prematurity, which leads to lower birth weight, and some may be due to a higher incidence of anemia, which is a risk factor for LBW (14). Post-term pregnancy was more prevalent among rural mothers. We could not find any previous studies linking post-term pregnancy to living residency. The mother is required to visit a well-equipped medical center at least several times a week for fetal heart rate tracing and ultrasound in post-term pregnancies. Due to the distance dimension, this is not always possible for rural mothers. As a result, a significant number of these mothers wait until the last day of delivery before going to the hospital.
The rate of neonatal resuscitation and NICU admission was strongly related to living residency. Rural mothers were at higher risk for neonatal resuscitation and NICU admission. Neonatal morbidities such as prematurity, LBW, and post-term pregnancy all increase the likelihood of resuscitation and NICU admission. However, in line with a previous study (11), the rate of neonatal death was similar in urban and rural mothers.
Our study's most intriguing finding was that rural mothers had a lower risk of cesarean section. Living in a rural area appears to be a protective factor for cesarean delivery. An investigation into the indications for cesarean section in rural and urban mothers would aid us in better understanding the reasons for these differences.
The strength of our study is that our study registers are of high quality and in accordance with childbirth records. We investigated various maternal and neonatal outcomes. Our study was conducted retrospectively, which is still a limitation. The database did not allow for the precise timing of the various events during pregnancy. More data was missing for variables, such as body mass index.