house officers have put many general practitioners off. "GP trainees are reared on a diet of abnormality and fear. It's surprising they are not put off maternity care for life," he said. "GPs do not have the experience of helping midwives at home. The government may decide that a medical component in the community is unnecessary-all that is needed is a fast ambulance and an open road. It will probably just ask GPs to do their best."

INTRODUCTION: Low food access has been associated with an increased risk of obesity and cardiovascular disease, but little is known if food access increases the likelihood of adverse pregnancy outcomes. We aimed to determine if living in an area of low food access is associated with an increased prevalence of preterm birth in Florida. METHODS: We linked, at the census tract level, data on food access from the United States Department of Agriculture (USDA) Food Access Research Atlas to pregnancy outcome data from the Florida Community Health Assessment Research Tool Set. We defined a census tract as “low access to healthy food” if the tract was both low income and a significant number (≥500) or proportion (33%) of the population lives more than 1 mile (urban areas) or 10 miles (rural areas) from the nearest supermarket. Prevalence ratios and 95% confidence intervals were calculated using modified Poisson regression models. RESULTS: We analyzed 2,368,114 births in the state of Florida from 2008-2018 with nonmissing gestational age and food access designation. The preterm birth rate was 10.9% and 10.1% in areas with and without low food access, respectively. We calculated a prevalence ratio of 1.04 (95% CI 1.03–1.05) for the association between preterm birth and low food access after adjustment for maternal race/ethnicity. CONCLUSION: Living in an area of low food access was associated with a slight increase in prevalence of preterm birth in Florida. Food access and other measures of neighborhood deprivation may play a role in the risk of adverse perinatal outcomes.

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