Abstract
BackgroundThe reduction of the preterm delivery (PTD) rate is a maternal and child health target. Elevated rates have been found among several immigrant groups, but few studies have distinguished between PTD according to the mode of birth start. In addition, migrants’ birth outcomes have further been shown to be affected by the time in residence; however, the association to PTD subtypes has not previously been assessed. In this study we examined if the risk of spontaneous and non-spontaneous, or iatrogenic, PTD among immigrants in Norway varied according to the length of residence and the country of birth, and compared with the risks among the majority population.MethodsWe linked population-based birth and immigration data for 40 709 singletons born to immigrant women from Iraq, Pakistan, the Philippines, Somalia, Sri Lanka and Vietnam and 868 832 singletons born to non-immigrant women from 1990–2009. Associations between the length of residence and subtypes of PTD were estimated as relative risks (RRs) with 95% confidence intervals (CIs) from multivariable models.ResultsIn total, 48 191 preterm births occurred. Both spontaneous and non-spontaneous PTD rates were higher among immigrants (4.8% and 2.0%) than among non-immigrants (3.6% and 1.6%). Only non-spontaneous PTD was associated with longer lengths of residence (p trend <0.001). Recent immigrants (<5 years of residence) and non-immigrants had a similar risk of non-spontaneous PTD, whereas immigrants with lengths of residence of 5–9 years, 10–14 years and ≥15 years had adjusted RRs of 1.18 [95% CI 1.03,1.35], 1.43 [95% CI 1.20,1.71] and 1.66 [95% CI 1.41,1.96]. The association was reduced after further adjustments for maternal and infant morbidity. Conversely, the risk of spontaneous PTD among immigrants was not mitigated by length of residence, but varied with country of birth according to the duration of pregnancy in term births.ConclusionsNon-spontaneous PTD increased with the length of residence whereas spontaneous PTD remained elevated regardless of the length of residence. Policies to improve birth outcomes in ethnically mixed populations should address the modifiable causes of PTD rather than aiming to reduce absolute PTD rates.
Highlights
The reduction of the preterm delivery (PTD) rate is a maternal and child health target
Demographic and health related characteristics Immigrants differed from non-immigrants with respect to demographic covariates and these characteristics were associated with the length of residence (Table 1)
Gestational and pregestational diabetes and giving birth to an small- for-gestational age (SGA) infant were more common among most immigrant groups, whereas hypertensive disorders and giving birth to an large-forgestational age (LGA) infant occurred less often in immigrants compared with non-immigrants (Tables 2 and 3)
Summary
The reduction of the preterm delivery (PTD) rate is a maternal and child health target. In this study we examined if the risk of spontaneous and non-spontaneous, or iatrogenic, PTD among immigrants in Norway varied according to the length of residence and the country of birth, and compared with the risks among the majority population. As an indicator of adverse pregnancy outcome, a reduction of the PTD rate, in general, is a maternal and child health target. Differences in the duration of pregnancy could potentially influence PTD rates, especially among groups with short gestational lengths. This would be more likely to influence spontaneous PTD rates. Few studies of ethnic disparities in the risk of PTD have differentiated between PTD subtypes and different methods for the determination of gestational length have been used [8,17]
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