Abstract
BackgroundTo compare the prevalence of preterm birth, post term birth, intra-uterine growth restriction and distribution of Apgar scores in offspring of foreign-born women in Western Australia with that of their Australian-born non-Indigenous and Indigenous counterparts.MethodsA population-based linked data study, involving 767,623 singleton births in Western Australia between 1980 and 2010 was undertaken. Neonatal outcomes included preterm birth, post term births, intra-uterine growth restriction (assessed using the proportion of optimal birth weight) and low Apgar scores. These were compared amongst foreign-born women from low, lower-middle, upper middle and high income countries and Australian-born non-Indigenous and Indigenous women over two different time periods using multinomial logistic regression adjusted for covariates.ResultsCompared with Australian born non-Indigenous women, foreign-born women from low income countries were at some increased risk of extreme preterm (aRRR 1.59, 95% CI 0.87, 2.89) and very early preterm (aRRR 1.63, 95% CI 0.92, 2.89) births during the period from 1980 to 1996. During the period from 1997 to 2010 they were also at some risk of extreme preterm (aRRR 1.42, 95% CI 0.98, 2.04) very early preterm (aRRR 1.34, 95% CI 1.11, 1.62) and post term birth (aRRR 1.93, 95% CI 0.99, 3.78). During this second time period, other adverse outcomes for children of foreign-born women from low income and middle income countries included increases in severe (aRRR 1.69, 95% CI 1.30, 2.20; aRRR 1.72, 95% CI 1.53, 1.93), moderate (aRRR 1.54, 95% CI 1.32, 1.81; aRRR 1.59, 95% CI 1.48, 1.70) and mild (aRRR 1.28, 95% CI 1.14, 1.43; aRRR 1.31, 95% CI 1.25, 1.38) IUGR compared to children of Australian-born non-Indigenous mothers. Uniformly higher risks of adverse outcomes were also demonstrated for infants of Indigenous mothers.ConclusionsOur findings illustrate the vulnerabilities of children born to foreign women from low and middle-income countries. The need for exploratory research examining mechanisms contributing to poorer birth outcomes following resettlement in a developed nation is highlighted. There is also a need to develop targeted interventions to improve outcomes for these women and their families.
Highlights
To compare the prevalence of preterm birth, post term birth, intra-uterine growth restriction and distribution of Apgar scores in offspring of foreign-born women in Western Australia with that of their Australianborn non-Indigenous and Indigenous counterparts
Australian-born mothers of indigenous background (AI) mothers were more likely to be aged less than 20 years (27.2%) compared to Australian-born mothers of non-indigenous backgrounds (ANI)
Pearson chi2 (25) 2.1 × 10+ 4 Pr < 0.001 mothers and foreign mothers, whilst Foreign-born mothers from lower middle-income countries (FB-LMIC) mothers were less likely to be aged less than 20 years of age than ANI mothers (1.9 vs 5.6%)
Summary
To compare the prevalence of preterm birth, post term birth, intra-uterine growth restriction and distribution of Apgar scores in offspring of foreign-born women in Western Australia with that of their Australianborn non-Indigenous and Indigenous counterparts. Several studies have found that foreign-born women living in developed countries are at increased risk of adverse obstetric and perinatal outcomes including preterm delivery, low birth weight, IUGR, Caesarean section, postpartum haemorrhage and neonatal mortality and infection [11,12,13,14,15,16,17]. Obstetric profiles, including maternal medical conditions and pregnancy complications, of foreign-born women of culturally and linguistically diverse (CALD) backgrounds have been compared with those of Australian-born women [11, 18, 19] using population-based data linkage In these studies foreignborn women, especially those from Sub-Saharan Africa, Southeast Asia and Southern and Central Asia, were more likely to undergo emergency Caesarean section, often because of failure of labour to progress and fetal distress [18, 19]. The literature demonstrates the variability in the accuracy of the measurement of fetal growth in children of immigrant backgrounds [15, 16], and suggests that the use of fetal and newborn charts as single diagnostic tools (birthweight and gestational age charts) in determining perinatal outcomes may be debatable [21, 22]
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