Rural Residence and Adverse Pregnancy Outcomes in the United States: Epidemiologic Insights and Perspectives

Adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, gestational diabetes, preterm birth, restricted intrauterine growth, and intrauterine fetal demise are often associated with pregnancy-related mortality and maternal mortality. Furthermore, APOs complicate the care of pregnant women, leading to worse short- and long-term outcomes, especially for women from underserved areas. However, the occurrence of APOs has received considerably less attention in rural areas, which are often socioeconomically disadvantaged and are burdened by significant health disparities. This review article provides epidemiologic insights into the distribution and potential determinants of APOs among women living in rural communities in the United States. Additionally, it addresses intrinsic and extrinsic factors pertaining to biology, social factors, and environmental factors that potentially influence the incidence of APOs in rural areas. Finally, the success of interventions implemented to improve access to health care to reduce APOs, perspectives, and challenges posed by APOs among women living in rural areas are also discussed. · APOs lead to substantial morbidity and mortality.. · Several APOs are less studied in rural populations.. · Rural areas often have significant health disparities that influence pregnancy outcomes.. · More epidemiological studies of APOs in rural areas are needed..