Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe

Survival and quality of life are improved for very preterm babies when delivery occurs in a maternityunit with on-site neonatal intensive care (level III unit). We investigated the impact of distance on the probability of delivering in such a unit for births before 32weeks of gestation from 9 European regions with diverse perinatal health systems (the MOSAIC cohort). We analysed distances between women's homes, and the nearest level III in population quartiles, adjusting for maternal and pregnancy characteristics. Living farther away from a level III reduced access to specialisedcare everywhere; in some regions women residing in the fourth quartile were half as likely to deliver in level III units as those in the first. To improve regionalized perinatal care the spatial location of level III units should be taken into account.