Management of the pregnant immigrant woman in the decade 1992 – 2001

Caesarean delivery in a migration context: the role of prior delivery in the host country

Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000–2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3–12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2–18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.

The relationship between internal migration and the likelihood of high-risk pregnancy: Hukou system and high-risk pregnancies in China

BACKGROUND

China has one of the world's largest internal migrant populations. The Chinese Hukou system is a unique household registration system that limits internal migrants in their access to basic urban public services, such as public health insurance and social assistance of their host city. In the case of female internal migrants, this may lead to high-risk pregnancies. The objective of this study is to assess the relationship between internal migrant status (Hukou) and the likelihood of high-risk pregnancies that occur in one large municipal-level obstetrics hospital in Shanghai, China.

METHODS

Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013, to May 31, 2018, were used to analyze 133,358 live births for Shanghai natives (n = 83,872) and internal migrant women (n = 49,486). A propensity score matching approach was used in conjunction with logistic regression analysis to identify the role of internal migrant status (Hukou) on the likelihood of high-risk pregnancies.

RESULTS

A greater likelihood of high-risk pregnancies were found among internal migrant women who moved from other parts of China to Shanghai. This effect was more obvious for women who gave birth for the first time and internal migrant women who were employed.

CONCLUSION

The results show the effects of internal migrant status (Hukou) and the elevated likelihood of high-risk pregnancies among internal migrant women relative to their urban counterparts in Shanghai even after accounting for self-selection by employing the propensity score matching method. China's unique Hukou household registration system limits access to public services for internal migrant women and accordingly may account for the elevated likelihood of high-risk pregnancies.

Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study

OBJECTIVES

We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.

METHODS

A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st^, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.

RESULTS

There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.

CONCLUSIONS

Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.

Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany

Background

Cesarean rates are higher in women admitted to labor ward during early stages rather than at later stages of labor. In a study in Germany, crude cesarean rates among Turkish and Lebanese immigrant women were low compared to non-immigrant women. We evaluated whether these immigrant women were admitted during later stages of labor, and if so, whether this explains their lower cesarean rates.

Methods

We enrolled 1413 nulliparous women with vertex pregnancies, singleton birth, and 37+ week of gestation, excluding elective cesarean deliveries, in three Berlin obstetric hospitals. We applied binary logistic regression to adjust for social and obstetric factors; and standardized coefficients to rank predictors derived from the regression model.

Results

At the time of admission to labor ward, a smaller proportion of Turkish migrant women was in the active phase of labor (cervical dilation: 4+ cm), compared to women of Lebanese origin and non-immigrant women. Rates of cesarean deliveries were lower in women of Turkish and Lebanese origin (15.8 and 13.9%) than in non-immigrant women (23.9%). In the logistic regression analysis, more advanced cervical dilatation was inversely associated with the outcome cesarean delivery (OR: 0.76, 95%CI: 0.70–0.82). In addition, higher maternal age (OR: 1.06, 95%CI: 1.04–1.09), application of oxytocic agents (OR: 0.55, 95%CI: 0.42–0.72), and obesity (OR: 2.25, 95%CI: 1.51–3.34) were associated with the outcome. Ranking of predictors indicate that cervical dilatation is the most relevant predictor derived from the regression model.

Conclusions

Advanced cervical dilatation at the time of admission to labor ward does not explain lower emergency cesarean delivery rates in Turkish and Lebanese migrant women, despite the fact that this is the strongest among the predictors for emergency cesarean delivery identified in this study.

Pregnancy and Birth Outcomes Among Immigrant Women in the US and Europe: A Systematic Review

Human migration is not a new phenomenon, but it has changed significantly with the advance of globalization. We focus on differences in the published literature concerning migration and health (EU vs the US), centering specifically on reproductive health outcomes. We conducted a literature search in the Pubmed and Embase databases. We reviewed papers that contrast migrants to native-born populations and analyzed differences between countries as well as challenges for future research. The prevalence of low birthweight among migrants varies by the host country characteristics as well as the composition of migrants to different regions. The primary driver of migrant health is the migrant "regime" in different countries at specific periods of time. Future health outcomes of immigrants will depend on the societal characteristics (legal protections, institutions and health systems) of host countries.

Reproductive health research of women migrants to Western countries: A systematic review for refining the clinical lens

Influxes of migrant women of childbearing age to Western receiving countries have made their reproductive health a priority in those countries. Yet, providing optimal care to these women may be hampered by an inadequate volume or quality of research to inform practice. We reviewed reports of studies recently published to assess the extent to which current research is able to inform reproductive health care practices for migrant women (i.e., those born in countries other than the receiving country)--in so doing, we sought to offer a view of the landscape from which clinicians may interpret relevant publications. Additionally, we sought to identify topics for which clinicians may choose to advocate for additional research to be performed.

Migrationshintergrund als Risikofaktor für die Entwicklung Frühgeborener im Alter von zwei Jahren

Zusammenfassung. Im Rahmen der Aachener Frühgeborenennachsorge wurden N = 199 Frühgeborene (< 32 SSW und/oder < 1500 g) der Geburtsjahrgänge 2007 bis 2011 im Alter von korrigiert zwei Jahren entwicklungsneurologisch nachuntersucht und ihr MDI mit dem Bayley II ermittelt. Die Daten wurden retrospektiv analysiert, um herauszufinden, ob der Migrationshintergrund die kognitive Leistungsfähigkeit zum Untersuchungszeitpunkt beeinflusst. Es zeigten sich keine Unterschiede hinsichtlich des Geschlechts, medizinischer Komplikationen und der Inanspruchnahme von Therapie zwischen Kindern mit (42 %) und ohne (58 %) Migrationshintergrund. In Übereinstimmung mit der Literatur lag die gesamte Aachener Stichprobe mit einem mittleren MDI von 83,3 (SD 17,4) eine Standardabweichung unter dem Durchschnitt der Referenzpopulation. Kinder mit Migrationshintergrund lagen im kognitiven Outcome 10 Punkte unter Kindern ohne diesen, was entscheidend durch das Vorliegen familiärer Risikofaktoren bedingt wurde. Im regressionsanalytischen Modell hatten familiäre Risikofaktoren und das Geburtsgewicht den größten Einfluss auf den kognitiven Outcome; aber auch das Vorliegen eines Migrationshintergrundes leistete einen zusätzlichen Beitrag zur Vorhersage. Frühgeborene mit Migrationshintergrund sollten daher als besondere Risikogruppe erkannt werden, insbesondere wenn sie zusätzlich familiäre Risikofaktoren aufweisen, um sie frühzeitig differenzierter fördern zu können.

Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany

Objective

The frequency of caesarean section delivery varies between countries and social groups. Among other factors, it is determined by the quality of obstetrics care. Rates of elective (planned) and emergency (in-labor) caesareans may also vary between immigrants (first generation), their offspring (second- and third-generation women), and non-immigrants because of access and language barriers. Other important points to be considered are whether caesarean section indications and the neonatal outcomes differ in babies delivered by caesarean between immigrants, their offspring, and non-immigrants.

Methods

A standardized interview on admission to delivery wards at three Berlin obstetric hospitals was performed in a 12-month period in 2011/2012. Questions on socio-demographic and care aspects and on migration (immigrated herself vs. second- and third-generation women vs. non-immigrant) and acculturation status were included. Data was linked with information from the expectant mothers’ antenatal records and with perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, parity and socio-economic status.

Results

The caesarean section rates for immigrants, second- and third-generation women, and non-immigrant women were similar. Neither indications for caesarean section delivery nor neonatal outcomes showed statistically significant differences. The only difference found was a somewhat higher rate of crash caesarean sections per 100 births among first generation immigrants compared to non-immigrants.

Conclusion

Unlike earlier German studies and current studies from other European countries, this study did not find an increased rate of caesarean sections among immigrants, as well as second- and third-generation women, with the possible exception of a small high-risk group. This indicates an equally high quality of perinatal care for women with and without a migration history.

Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process

Background

Through the World Health Assembly Resolution, ‘Health of Migrants’, the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries.

Methods

This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada.

Results

A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created - the Migrant Friendly Maternity Care Questionnaire (MFMCQ) – in three languages (English, French and Spanish). It is completed in 45 minutes via interview administration several months post-birth.

Conclusions

A 4-stage process of questionnaire development with international experts in migrant reproductive health and research resulted in the MFMCQ, a questionnaire measuring key aspects of migrant-sensitive maternity care. The MFMCQ is available for further translation and use to examine and compare care and perceptions of care within and across countries, and by key socio-demographic, migration, and obstetrical characteristics of migrant women.

Comparison of Perinatal Data of Immigrant Women of Turkish Origin and German Women - Results of a Prospective Study in Berlin

Aims: The aim of the study was to compare obstetrical process indicators and outcomes for German women with women of Turkish origin residing in Germany. Do women of Turkish origin attend antenatal examinations as frequently as non-immigrant women? Are high-risk pregnancies and anemia more common among immigrant women? Are the rates for epidural analgesia (PDA) and combined spinal-epidural analgesia (CSE) during delivery the same for immigrant women compared to German women? Are there identifiable differences in the mode of delivery and in perinatal outcomes? Patient Population/Methods: Data were obtained from 3 maternity clinics in Berlin for the period 2011 to 2012. The questionnaires covered socio-demographic factors and information on prenatal care as well as immigration/acculturation. The data obtained from these questionnaires was supplemented by information obtained from the official maternal record of prenatal and natal care (Mutterpass) and perinatal data recorded by the clinic. Results: The response rate was 89.6 %; the data of 1277 women of Turkish origin who had immigrated to Germany or whose family had immigrated and of 2991 non-immigrant women in Germany were included in the study. Regression analysis showed no statistically significant difference in the number of antenatal examinations between immigrant and non-immigrant women. Women of Turkish origin born in Germany had a significantly higher risk of postpartum anemia. PDA/CSE rate, arterial umbilical cord pH and 5-minute Apgar scores did not differ. The incidence of cesarean sections (elective and secondary) was significantly lower in the population of immigrant women of Turkish origin. Conclusion: Outcomes for most perinatal parameters were comparable for immigrant and non-immigrant women. These results indicate that the achieved standards of antenatal care and medical care during pregnancy are similar for Turkish immigrant women compared to non-immigrant women in maternity clinics in Berlin. The higher rates of anemia among immigrant women should be targeted by preventive measures.

Japanese men's success in altered fatherhood role in a foreign country

This study explores the meaning of the lived experience of childbirth and parenting of Japanese men who became fathers in a foreign country. Japanese men have been raised to maintain very strict gender roles, excluding them from sharing with their wives the experience of childbirth and the day-to-day parenting of young children. The study employed a descriptive phenomenological approach with in-depth interviews. Participants included nine Japanese men born and raised in Japan who were living in Honolulu. Three theme categories emerged from the data: "making active efforts in preparation for childbirth in a foreign country"; "challenges in pregnancy, childbirth, child care, and as husbands or partners"; and "challenges in transition to parenthood." Japanese men successfully altered their transitional and authoritarian gender role to a family orientated social structure, under the influence of Western values, when living in foreign country. By spending more time with their new family, they acknowledged the processes of becoming a father. The ability to adapt their expectations of fatherhood in line with Western values was enhanced by the support of coworkers, their mature age, rich educational background, and the personal financial resources of the male participants in the study.

International migration and caesarean birth: a systematic review and meta-analysis

Background

Perinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated. A systematic review was conducted to determine if migrants in Western industrialized countries consistently have different rates of caesarean than receiving-country-born women and to identify the reasons that explain these differences.

Methods

Reports were identified by searching 12 literature databases (from inception to January 2012; no language limits) and the web, by bibliographic citation hand-searches and through key informants. Studies that compared caesarean rates between international migrants and non-migrants living in industrialized countries and that did not have a ‘fatal flaw’ according to the US Preventative Services Task Force criteria were included. Studies were summarized, analyzed descriptively and where possible, meta-analyzed.

Results

Seventy-six studies met inclusion criteria. Caesarean rates between migrants and non-migrants differed in 69% of studies. Meta-analyses revealed consistently higher overall caesarean rates for Sub-Saharan African, Somali and South Asian women; higher emergency rates for North African/West Asian and Latin American women; and lower overall rates for Eastern European and Vietnamese women. Evidence to explain the consistently different rates was limited. Frequently postulated risk factors for caesarean included: language/communication barriers, low SES, poor maternal health, GDM/high BMI, feto-pelvic disproportion, and inadequate prenatal care. Suggested protective factors included: a healthy immigrant effect, preference for a vaginal birth, a healthier lifestyle, younger mothers and the use of fewer interventions during childbirth.

Conclusion

Certain groups of international migrants consistently have different caesarean rates than receiving-country-born women. There is insufficient evidence to explain the observed differences.

Cesarean section rate differences by migration indicators

PURPOSE

To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators?

METHODS

Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed.

RESULTS

Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8-27.3). Cesarean section rates of African women were consistently high (31-33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %).

CONCLUSION

Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.

International migration and adverse birth outcomes: role of ethnicity, region of origin and destination

BACKGROUND

The literature on international migration and birth outcomes shows mixed results. This study examined whether low birth weight (LBW) and preterm birth differed between non-migrants and migrant subgroups, defined by race/ethnicity and world region of origin and destination.

METHODS

A systematic review and meta-regression analyses were conducted using three-level logistic models to account for the heterogeneity between studies and between subgroups within studies.

RESULTS

Twenty-four studies, involving more than 30 million singleton births, met the inclusion criteria. Compared with US-born black women, black migrant women were at lower odds of delivering LBW and preterm birth babies. Hispanic migrants also exhibited lower odds for these outcomes, but Asian and white migrants did not. Sub-Saharan African and Latin-American and Caribbean women were at higher odds of delivering LBW babies in Europe but not in the USA and south-central Asians were at higher odds in both continents, compared with the native-born populations.

CONCLUSIONS

The association between migration and adverse birth outcomes varies by migrant subgroup and it is sensitive to the definition of the migrant and reference groups.

Migration to western industrialised countries and perinatal health: a systematic review

Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in western industrialised countries have consistently poorer perinatal health than receiving-country women. A systematic review of literature from Medline, Health Star, Embase and PsychInfo from 1995 to 2008 included studies of migrant women/infants related to pregnancy or birth. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not western and industrialised. Studies were assessed for quality, analysed descriptively and meta-analysed when possible. We identified 133 reports (>20,000,000 migrants), only 23 of which could be meta-analysed. Migrants were described primarily by geographic origin; other relevant aspects (e.g., time in country, language fluency) were rarely studied. Migrants' results for preterm birth, low birthweight and health-promoting behaviour were as good or better as those for receiving-country women in >or=50% of all studies. Meta-analyses found that Asian, North African and sub-Saharan African migrants were at greater risk of feto-infant mortality than 'majority' receiving populations, and Asian and sub-Saharan African migrants at greater risk of preterm birth. The migration literature is extensive, but the heterogeneity of the study designs and definitions of migrants limits the conclusions that can be drawn. Research that uses clear, specific migrant definitions, adjusts for relevant risk factors and includes other aspects of migrant experience is needed to confirm and understand these associations.

[Hospital admission in newborns according to ethnicity and parents' country of origin in an urban area of Barcelona [Spain]]

OBJECTIVE

The birth rate in Spain has increased due to the continuous rise in the number of immigrants. Ethnic origin and socioeconomic position can be determining factors in differences in maternal and child health. The aim of the present study was to determine the possible existence of differences in neonatal diagnoses according to parental ethnic origin.

METHODS

We performed a retrospective, cross-sectional study of all live newborns delivered in Hospital del Mar (Barcelona) between 2003 and 2005. The variables studied were risk of admission, diagnostic classes, and parental ethnic group.

RESULTS

Of the 2118 newborns included in this study, 46.7% were of immigrant origin (mainly from Central and South America) and 6.4% were gypsies. More than 60% of the 1445 admitted newborns were included in the diagnostic class of risk or suspicion of infection. The risk of pregnancy with little or no prenatal care was higher in non-native and gypsy newborns (OR = 2.58; 95%CI: 1.76-3.77, and OR = 5.84; 95%CI: 3.45-9.90, respectively). The risk of low birth weight and maternal drug use were lower in non-native newborns (OR = 0.17; 95%CI: 0.03-0.90, and OR = 0.12; 95%CI: 0.03-0.44, respectively).

CONCLUSIONS

Differences in non-native and gypsy newborns compared with native newborns are not due to imported or genetic diseases but are probably due to differences in the social and cultural environment during pregnancy. Preventive measures should be promoted and reinforced and access to and the quality of primary care should be improved in these mothers and their infants.

Low maternal awareness of fetal movement is associated with small for gestational age infants

Our aim was to identify associations between information given to pregnant women about fetal activity, level of maternal awareness of fetal activity, maternal concern about decreased fetal movement, and pregnancy outcomes. This was a population-based cross-sectional study. Mothers with a singleton delivery were invited to answer an anonymous structured questionnaire before discharge from the delivery unit. Six hundred and ninety-one mothers participated (60.4% of eligible women). Women were highly aware of fetal activity. Yet, 25% did not receive any information from care providers about expected normal fetal activity. Receiving information about fetal activity was associated with increased maternal awareness (odds ratio, 2.0; 95% confidence interval [CI], 1.2-3.4). Low maternal awareness of fetal activity was associated with an increased risk of having a small for gestational age infant (odds ratio, 6.5; 95% CI, 3.5-12.3). Expectations about the normal frequency of fetal movements, as reported by the mothers, varied from 25 kicks/hour to 3 kicks/24 hours. Receiving information about expected fetal activity was associated with maternal concerns about decreased fetal movement, but not with improved outcomes. We conclude that receiving information about expected fetal activity was associated with maternal concerns, but not with improved outcomes.

[Immigrant pregnancy and neonatal morbidity]

INTRODUCTION

Over the past few years immigration has become an important growth issue in Spain, with the subsequent social, economic and health impact it produces.

OBJECTIVE

To analyze the characteristics of immigrant pregnancy and its neonatal morbidity.

METHOD

Prospective, descriptive, and cross-sectional study, which includes live-born infants born in the Hospital de Sabadell, from the 1st of September until the 31st of December, 2004. All demographic data were collected, together with details of the pregnancy, the labour, the infant and its associated morbidity.

RESULTS

There were 902 births during this period, of which 159 (17.6%) were immigrant pregnancies, with Latin Americans and Moroccans predominant. About 83.3% of immigrant pregnancies where of mothers who have lived in Spain for less than 5 years. The average age of immigrant pregnancies was 27 years (p<0.001), multiparous is more frequent (p<0.001) and have a lower control of pregnancy than non-immigrant (p=0.001). The average gestational age is similar between both groups, nevertheless, the average weight is significantly higher in immigrant women newborns (p<0.05). About 36.5% of the newborns are admitted with their mother o in the neonatal unit, with the main reason for admission being the risk of infection with a predominance between the newborns of immigrant pregnancies (p=0.05). The number of newborns admitted in the neonatal unit is similar in both groups.

CONCLUSIONS

This study allowed us to look at characteristics of immigrant pregnancies and draw conclusions in providing the necessary medical assistance for this new and growing population.

Preterm delivery risk in migrants in Italy: an observational prospective study

BACKGROUND

Various studies have ascertained different birth outcomes between resident and migrant populations in western countries. Considering preterm delivery (<37 complete weeks of gestation) as a perinatal risk condition, we assessed its rate in migrant and native Italian women who delivered in the main public hospital in Brescia (Italy).

METHODS

All migrant puerperas and a random sample of native puerperas hospitalized during the period February to May 2005 were included in the study after informed consent and filled in a self-administered multilanguage questionnaire enquiring about sociodemographic and obstetric data. Additional information including last menstrual period was obtained from personal obstetric records.

RESULTS

As many as 471 puerperas entered the study: 366 Italian and 105 migrant women coming from eastern Europe (41.9%), Asia (20%), South America (10.5%), and Africa (27.6%). Of the migrant population, 67 of 105 (63.8%) were at their first delivery in Italy (median interval from arrival: 3.8 y). Gestational age at delivery was assessed for 456 of 471 women (103 migrants and 353 Italians). A total of 36 (7.9%) preterm deliveries were registered: 22 (6.2%) in Italian and 14 (13.6%) in migrant puerperas (p value = 0.015). The highest preterm delivery rate was observed in African women (20.7%), while women from eastern Europe had a similar rate to Italians. In univariate analysis, factors associated to preterm delivery were parity and length of permanence in Italy. We could not demonstrate any correlation with smoking or with a delayed access to antenatal care (first obstetric evaluation after 12 complete weeks of gestation). In multivariate analysis, African origin was the only independent risk factor for preterm delivery [odds ratio (OR) = 3.54; p = 0.018].

CONCLUSIONS

In our setting, preterm delivery occurred more frequently in migrant women, particularly of African origin, and it is not associated to delayed access to antenatal care.

Childbirth overseas: the experience of Japanese women in Hawaii

The purpose of this study is to investigate which kinds of stress women experience during childbirth in a foreign country and to explore whether childbirth in a foreign country influences women's mental health. The study was a quantitative and qualitative mixed study. Forty-five Japanese women, born and raised in Japan and who gave birth in Hawaii, USA, were telephone-interviewed within 1 year after childbirth. The stress factors that emerged were: language barrier, distance from family and friends, different culture, and health-care attitude about childbirth. Half of the participants experienced emotional dysfunction during their pregnancy. All primiparas experienced postpartum depression. The participants who had the maternity blues tended to have postpartum depression. Help from the participants' mothers after childbirth decreased postpartum depression. The importance of mental health for foreign-born primiparas emerges during the perinatal period.

[Perinatal outcomes in immigrant women]

OBJECTIVES

To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns.

PATIENTS AND METHODS

All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated.

RESULTS

There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01).

CONCLUSIONS

In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate.

Perinatal outcome in Berlin (Germany) among immigrants from Turkey

PURPOSE

Are there differences regarding important perinatal outcome-parameters in Berlin relating to ethnicity?

PATIENTS AND METHODS

A database was available covering 152,193 single deliveries in all hospitals in Berlin/Germany in the period 1993-1999, including 132,555 German women and 19,638 women of other ethnicities. Comparisons were made between a total of four pairs of sub-groups matched in terms of parity and social status (significance level P < 0.01).

RESULTS

Pregnant migrants come for their first antenatal check-up significantly later, thus delaying the initiation of necessary diagnostic or therapeutic measures. Migrants show higher rates of prepartal and also postpartal anemia than the German women. In all sub-groups the German women had a significantly higher frequency of planned cesarean sections. Migrants were significantly less likely to receive an epidural anesthesia during delivery. It is also noticeable that the rate of congenital malformations of neonates is significantly higher in the migrant collectives.

CONCLUSIONS

Important perinatal quality parameters such as infant and maternal mortality and rates of premature delivery have largely converged between German and Turkish migrant mothers. The differences found (e.g., rates of planned cesarean section, epidural anesthesia, or anemia) could be interpreted as indications of persistent differences in quality of care for migrants.