Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; The First Nations Cancer & Wellbeing Research (FNCWR) Program, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia.
Midwifery. 2023 Aug;123:103704. doi: 10.1016/j.midw.2023.103704. Epub 2023 May 3.
In Australia, area of residence is an important health policy focus and has been suggested as a key risk factor for preterm birth (PTB), low birth weight (LBW) and cesarian section (CS) due to its influence on socioeconomic status, access to health services, and its relationship with medical conditions. However, there is inconsistent evidence about the relationship of maternal residential areas (rural and urban areas) with PTB, LBW, and CS. Synthesising the evidence on the issue will help to identify the relationships and mechanisms for underlying inequality and potential interventions to reduce such inequalities in pregnancy outcomes (PTB, LBW and CS) in rural and remote areas.
Electronic databases, including MEDLINE, Embase, CINAHL, and Maternity & Infant Care, were systematically searched for peer-reviewed studies which were conducted in Australia and compared PTB, LBW or CS by maternal area of residence. Articles were appraised for quality using JBI critical appraisal tools.
Ten articles met the eligibility criteria. Women who lived in rural and remote areas had higher rates of PTB and LBW and lower rate of CS compared to their urban and city counterparts. Two articles fulfilled JBI's critical appraisal checklist for observational studies. Compared to women living in urban and city areas, women living in rural and remote areas were also more likely to give birth at a younger age (<20 years) and have chronic diseases such as hypertension and diabetes. They were also less likely to have higher levels of completing university degree education, private health insurance and births in private hospitals.
Addressing the high rate of pre-existing and/or gestational hypertension and diabetes, limited access of health services and a shortage of experienced health staff in remote and rural areas are keys to early identification and intervention of risk factors of PTB, LBW, and CS.
在澳大利亚，居住地区是一个重要的健康政策关注点，由于其对社会经济地位、获得卫生服务的机会以及与医疗条件的关系的影响，居住地区（农村和城市地区）被认为是早产（PTB）、低出生体重（LBW）和剖腹产（CS）的关键风险因素。然而，关于母亲居住地区（农村和城市地区）与 PTB、LBW 和 CS 之间的关系，证据并不一致。综合关于这一问题的证据将有助于确定农村和偏远地区妊娠结局（PTB、LBW 和 CS）不平等的关系和机制，以及潜在的干预措施来减少这些不平等。
系统检索了澳大利亚同行评议研究的电子数据库，包括 MEDLINE、Embase、CINAHL 和母婴护理，这些研究比较了母亲居住地区的 PTB、LBW 或 CS。使用 JBI 批判性评估工具评估文章的质量。
有 10 篇文章符合入选标准。与城市和城市地区的女性相比，居住在农村和偏远地区的女性 PTB 和 LBW 的发生率较高，CS 的发生率较低。有 2 篇文章符合 JBI 观察性研究的批判性评估清单。与居住在城市和城市地区的女性相比，居住在农村和偏远地区的女性也更有可能在较年轻的年龄（<20 岁）生育，并且更容易患有高血压和糖尿病等慢性疾病。她们也不太可能接受更高水平的大学学位教育、私人医疗保险和在私立医院分娩。
解决偏远和农村地区普遍存在的和/或妊娠期高血压和糖尿病、卫生服务获取有限以及经验丰富的卫生人员短缺等问题，是早期识别和干预 PTB、LBW 和 CS 风险因素的关键。
