Adverse perinatal outcomes in immigrants: A ten‐year population‐based observational study and assessment of growth charts

Abstract

A mother's country of birth is associated with the risk to poorer newborn outcomes -study of over 2 million babies born in Australia reveals (Figure 3). AbstractBackground: Maternity populations are becoming increasingly multiethnic.Conflicting findings exist regarding the risk of adverse perinatal outcomes among immigrant mothers from different world regions and which growth charts are most appropriate for identifying the risk of adverse outcomes.Objective: To evaluate whether infant mortality and morbidity, and the categorisation of infants as small for gestational age or large for gestational age (SGA or LGA) vary by maternal country of birth, and to assess whether the choice of growth chart alters the risk of adverse outcomes in infants categorised as SGA and LGA. Methods:A population cohort of 601 299 singleton infants born in Australia to immigrant mothers was compared with 1.7 million infants born to Australian-born mothers, 2004-2013. Infants were categorised as SGA and LGA according to a descriptive Australian population-based birthweight chart (Australia-2012 reference) and the prescriptive INTERGROWTH-21st growth standard. Propensity score reweighting was used for the analysis.Results: Compared to Australian-born infants, infants of mothers from Africa, Philippines, India, other Asia countries, and the Middle East had between 15.4% and 48.1% elevated risk for stillbirth, preterm delivery, or low Apgar score. The association between SGA and LGA and perinatal mortality varied markedly by growth chart and country of birth. Notably, SGA infants from African-born mothers had a relative risk of perinatal mortality of 6.1 (95% CI 4.3, 6.7) and 17.3 (95% CI 12.0, 25.0) by the descriptive and prescriptive charts, respectively.LGA infants born to Australian-born mothers were associated with a 10% elevated risk of perinatal mortality by the descriptive chart compared to a 15% risk reduction by the prescriptive chart. Conclusions:Country-of-birth-specific variations are becoming increasingly important for providing ethnically appropriate and safe maternity care. Our findings highlight significant variations in risk of adverse perinatal outcomes in immigrant subgroups, and demonstrate how the choice of growth chart alters the quantification of risk associated with being born SGA or LGA.A commentary based on this article appears on pages 433-435

Cross Cultural Workers for Women and Families From Migrant and Refugee Backgrounds: A Mixed-Methods Study of Service Providers Perceptions

“…This includes a higher burden of mental health issues [4,[8][9][10], pregnancy complications such as preeclampsia, and increased rates of caesarean section [11,12]. Infants born to migrant mothers are at increased risk of stillbirth [13][14][15][16], preterm birth, congenital anomalies [4], and admission to neonatal care units [11,17,18].…”

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

“…In Australia, over 2,000 families each year -six families each day -have a stillbirth, and there has been no improvement in stillbirth rates among late pregnancy stillbirths for over 20 years (5). Among women who were born elsewhere (6,7), women with lower socioeconomic status (8), and women who identify as Aboriginal and Torres Strait Islander (9), the risk of stillbirth is higher (4,10). Failure to identify and appropriately care for women with risk factors for stillbirth contributes to 20-50% of preventable stillbirths, which has potential to avoid 400 stillbirths each year for Australian families (11)(12)(13).…”

Protocol for the development and validation of a risk prediction model for stillbirths from 35 weeks gestation in Australia

“…Australia is a high-income country where over 2000 families each year-six families each day-have a stillbirth, and there has been no improvement in stillbirth rates among late pregnancy stillbirths for over 20 years [5,6]. Among women who were born elsewhere [7,8], women with lower socioeconomic status [9], and women who identify as Aboriginal and Torres Strait Islander [10], the risk of stillbirth is higher [4,11]. Failure to identify and appropriately care for women with risk factors for stillbirth contributes to 20-50% of preventable stillbirths, which has the potential to avoid 400 stillbirths each year for Australian families [12][13][14].…”