Rural Pregnancy Risks: Study Links Location to Lower Apgar Scores & Less Care

Babies born to mothers living in rural areas may face a higher risk of complications at birth, according to a new study from the Medical College of Georgia at Augusta University. Researchers found that infants born to mothers in rural communities were more likely to have lower Apgar scores, experience preterm delivery, and receive less prenatal care compared to those born to mothers in urban areas.

The Apgar score, a standardized assessment of a newborn’s health conducted at one and five minutes after birth, evaluates Appearance, Pulse, Grimace, Activity, and Respiration. Scores range from 0 to 10, with scores below six considered “non-reassuring,” potentially indicating a need for medical intervention. The study, presented at the ANESTHESIOLOGY® 2025 annual meeting and published in February 2026, analyzed data from nearly 3,000 mothers who delivered at a Georgia health center between November 2018 and October 2023.

“We saw that patients who live in rural areas were prone to have lower Apgar scores, lower rates of prenatal care and higher rates of preterm delivery,” explained Bibiana Avella, MD, a third-year anesthesiology resident at MCG who worked on the study. The research team utilized color-coded maps linked to patients’ zip codes to visually demonstrate disparities in maternal health outcomes between rural and urban regions.

The study revealed that 24% of mothers from rural areas (108 out of 442) had babies with non-reassuring Apgar scores, compared to 20% of mothers from urban areas (502 out of 2,510). While the sample sizes differ, the data suggests that babies born to mothers from rural areas were approximately 30% more likely to have these lower scores. Researchers also found that women in rural areas had fewer prenatal care visits and were more likely to deliver prematurely – before 37 weeks of pregnancy.

The findings underscore the significant impact of social determinants of health, particularly geographic location, on maternal and infant well-being. Factors such as financial status, transportation access, and education levels all contribute to a mother’s ability to receive adequate prenatal care. However, the study highlights location as a key variable influencing these outcomes.

According to the Georgia State Office of Rural Health, 141 of the state’s 159 counties are currently considered medically underserved. This lack of access to healthcare professionals and services can create a cascade of negative consequences for rural communities, including healthcare worker shortages, business closures, and limited access to specialized care.

The study also examined the impact of prenatal care itself. Researchers discovered that women who received no prenatal care were 2.6 times more likely to have babies with non-reassuring Apgar scores compared to those who did receive care. Infants delivered vaginally and closer to full term also tended to have better Apgar scores.

Anesthesiologists play a crucial role in obstetrics, managing pain and ensuring the safety of both mother and baby during labor and delivery, including providing epidurals, spinal blocks, and anesthesia for Cesarean sections. Mary Arthur, MD, anesthesiology residency program director and professor at MCG, emphasized the importance of expanding the perspective of residents to consider public health factors. “I really wanted residents to start looking at patients from a different public health perspective,” she said.

The researchers acknowledge that while the study demonstrates a correlation between rural residence and adverse birth outcomes, it does not definitively prove causation. However, the findings strongly suggest that limited access to healthcare in underserved areas contributes to poorer neonatal health. The team is planning to expand the study with a larger dataset to further investigate these relationships.

Augusta University is actively addressing these challenges through several initiatives, including the vidaRPM app and Maternal Care Model program, which provide remote monitoring and support for pregnant women and new mothers in rural areas. The university’s Center for Digital Health also operates a tele-OB ED pilot program, connecting rural hospitals with obstetric specialists at Wellstar MCG Health via telehealth.

“Telehealth is an amazing resource that MCG has,” said Arthur. “It’s amazing how people will be able to take ownership of their own health if they have the knowledge, and knowledge plays a very big role when it comes to something like this. A lot of people don’t know what they don’t know.”

The study’s authors emphasize the need for a multi-faceted approach to improve maternal and infant health in rural communities, including increased access to prenatal care, mobile clinics, transportation assistance, financial support, and investment in obstetric infrastructure and workforce development. “Where a mother lives shouldn’t determine whether her baby starts life healthy,” Arthur concluded. “Improving maternal health in rural and underserved areas requires coordinated clinical, community and policy-level action.”