Inequalities in maternal health and pregnancy outcome among Nigerian women migrated to Italy

Giovanni Zanconato, Elena Cavaliere, Chiara Beatrice Santoro, Sara Cascella, Alessia Pinto, Alice Comper, Fernanda Machungo

Abstract

Among migrant women, unfavourable health conditions and adverse obstetric events are observed more often than in native-born parturients. This observational retrospective study evaluated selected pregnancy outcomes in a Nigerian population giving birth at the University Hospital of Verona. Compared to national controls, being Nigerian was associated with preterm birth (aOR 1.6, 95% CI 1.1-2.2) and Cesarean section (aOR 2.2, 95% CI 1.5-2.7). No differences were found in rates of instrumental delivery and the immigrant group had half the risk of genital tears (aOR 0.6, 95% CI 1.1-2.2) with a higher likelihood of undamaged genitals (aOR 1.5, 95% CI 1.3-2.1). Perinatal indicators of neonatal distress were increased among Nigerians, namely a low Apgar score (aOR 2.6, 95% CI 1.4-4.9), NICU admission (aOR 1.7, 95% CI 1.1-2.8), and stillbirth (aOR 4.0, 95% CI 1.3-12.8). In conclusion, sub-Saharan African women of Nigerian origin appeared more vulnerable and exposed to several adverse pregnancy outcomes. These disparities call for the improvement of obstetric care in this immigrant group. (Afr J Reprod Health 2021; 25[4]: 43-51).

Full Text:

PDF

References

Rechel B, Mladovsky P, Ingleby D, Mackenbach JP and

McKee M. Migration and health in an increasingly diverse Europe. The Lancet. 2013 Apr ;381(9873):1235–45.

ISTAT. Natalità e Fecondità della Popolazione Residente

[Internet]. 2016. Available from: http://www.istat.it

Gagnon AJ and Redden KL. Reproductive health research

of women migrants to Western countries: A systematic review for refining the clinical lens. Best Pract Res Clin Obstet Gynaecol. 2016 Apr;32:3–14.

Diani F, Zanconato G, Foschi F, Turinetto A and Franchi

M. Management of the pregnant immigrant woman in the decade 1992 – 2001. J Obstet Gynaecol. 2003 Nov;23(6):615–7.

van den Akker T and van Roosmalen J. Maternal mortality

and severe morbidity in a migration perspective. Best Pract Res

Clin Obstet Gynaecol. 2016 Apr;32:26–38.

Urquia ML, Wanigaratne S, Ray JG and Joseph KS.

Severe Maternal Morbidity Associated With Maternal Birthplace: A Population-Based Register Study. J Obstet Gynaecol Can. 2017 Nov;39(11):978–87.

Roosmalen J, Schuitemaker NWE, Brand R, Dongen PWJ

and Gravenhorst JB. Substandard care in immigrant versus indigenous maternal deaths in The Netherlands. BJOG Int J Obstet Gynaecol. 2002 Feb;109(2):212–3.

Essén B, Hanson BS, Ostergren PO, Lindquist PG and

Gudmundsson S. Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden. Acta Obstet Gynecol Scand. 2000 Sep;79(9):737–43.

Malin M and Gissler M. Maternal care and birth outcomes

among ethnic minority women in Finland. BMC Public Health. 2009 Dec;9(1):84.

Carolan M. Pregnancy health status of sub-Saharan

refugee women who have resettled in developed countries: a review of the literature. Midwifery. 2010 Aug;26(4):407–14.

ISTAT. Indicatori demografici [Internet]. 2017. Available

from: http://www.istat.it

Lindsay KL, Gibney ER and McAuliffe FM. Maternal

nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries: Maternal nutrition among women from Sub-Saharan Africa. J Hum Nutr Diet. 2012 Dec;25(6):534–46.

WHO Regional Office for Europe. The Veneto model – a

regional approach to tackling global and European health challenges [Internet]. WHO Regional Office; 2016 p. 58. Available from: https://www.euro.who.int/__data/assets/pdf_file/0019/303184/The-Veneto-model-report.pdf

Regione Veneto. Registro Nascita 2019, Regione Veneto

[Internet]. Regione Veneto; 2019. Available from: https://www.ser-veneto.it/public/RapportoRegistroNascita2019.pdf

Certificato di assistenza al parto (CeDAP). Analisi

dell’evento nascita [Internet]. Ministero della Salute; 2016. Available from: http://www.salute.gov.it

Westerhuis MEMH, Visser GHA, Moons KGM, Zuithoff

PA, Mol BWJ and Kwee A. Cardiotocography Plus ST Analysis of Fetal Electrocardiogram Compared with Cardiotocography Only for Intrapartum Monitoring: A Randomized Controlled

Trial. Obstet Gynecol. 2010 Jun;115(6):1173–80.

Women’s Health and Education Center (WHEC) –

Diagnostic Ultrasound - List of Articles [Internet]. [cited 2021 Jun 7]. Available from: http://www.womenshealthsection.com/content/obsdu/articles.php3?s=4

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche

PC and Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344–9.

United Nations Development Programme. Human

Development Report 2015: Work for human development [Internet]. UN; 2016. (Human Development Report). Available from: https://www.un-ilibrary.org/content/books/9789210576154

Agbemenu K, Auerbach S, Murshid NS, Shelton J and

Amutah-Onukagha N. Reproductive Health Outcomes in African Refugee Women: A Comparative Study. J Womens Health. 2019 Jun;28(6):785–93.

Zanconato G, Iacovella C, Parazzini F, Bergamini V and

Franchi M. Pregnancy Outcome of Migrant Women Delivering in a Public Institution in Northern Italy. Gynecol Obstet Invest. 2011;72(3):157–62.

Villadsen SF, Mortensen LH and Andersen A-MN. Care

during pregnancy and childbirth for migrant women: How do we advance? Development of intervention studies – The case of the MAMAACT intervention in Denmark. Best Pract Res Clin Obstet Gynaecol. 2016 Apr; 32:100–12.

Boerleider AW, Wiegers TA, Manniën J, Francke AL and

Devillé WL. Factors affecting the use of prenatal care by non-western women in industrialized western countries: a systematic review. BMC Pregnancy Childbirth. 2013 Dec;13(1):81.

Gagnon AJ, Zimbeck M and Zeitlin J. Migration to

western industrialised countries and perinatal health: A systematic review. Soc Sci Med. 2009 Sep;69(6):934–46.

Sørbye IK, Wanigaratne S and Urquia ML. Variations in

gestational length and preterm delivery by race, ethnicity and migration. Best Pract Res Clin Obstet Gynaecol. 2016 Apr;32:60–8.

Goel MS. Obesity Among US Immigrant Subgroups by

Duration of Residence. JAMA. 2004 Dec 15;292(23):2860.

Oza-Frank R, Stephenson R and Venkat Narayan KM.

Diabetes Prevalence by Length of Residence Among US Immigrants. J Immigr Minor Health. 2011 Feb;13(1):1–8.

Lindsay KL, Gibney ER, McNulty BA and McAuliffe FM.

Pregnant immigrant Nigerian women: an exploration of dietary intakes. Public Health. 2014 Jul;128(7):647–53.

Leung G and Stanner S. Diets of minority ethnic groups in

the UK: influence on chronic disease risk and implications for prevention: Diets of minority ethnic groups in the UK. Nutr Bull. 2011 Jun;36(2):161–98.

ISTAT. Salute e sanità [Internet]. Available from:

https://www.istat.it/it/salute-e-sanit%C3%A0

Gagnon AJ, McDermott S, Rigol-Chachamovich J,

Bandyopadhyay M, Stray-Pedersen B and Stewart D. International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis: Migration and gestational diabetes mellitus. Paediatr Perinat Epidemiol. 2011 Nov;25(6):575–92.

Ministero della Salute. Diabete gestazionale [Internet].

Available from: https://www.salute.gov.it/portale/donna/dettaglioContenutiDonna.jsp?lingua=italiano&id=4493&area=Salute%20donna&menu=patologie

Anorlu RI, Iwuala NC and Odum CU. Risk factors for pre-

eclampsia in Lagos, Nigeria. Aust N Z J Obstet Gynaecol. 2005 Aug;45(4):278–82.

Nakimuli A, Chazara O, Byamugisha J, Elliott AM,

Kaleebu P, Mirembe F and Moffett A. Pregnancy, parturition and preeclampsia in women of African ancestry. Am J Obstet Gynecol. 2014 Jun;210(6):510-520.e1.

Merry L, Small R, Blondel B and Gagnon AJ.

International migration and caesarean birth: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013 Dec;13(1):27.

David M, Scherer K, Henrich W and Breckenkamp J. Does

an Immigrant Background Affect the Indication, Incidence or Outcome of Emergency Cesarean Section? Results of the Prospective Data Collection of 111 Births. Geburtshilfe Frauenheilkd. 2018 Feb;78(02):167–72.

Nybo Andersen A-M, Gundlund A and Villadsen SF.

Stillbirth and congenital anomalies in migrants in Europe. Best Pract Res Clin Obstet Gynaecol. 2016 Apr;32:50–9.

Racape J, De Spiegelaere M, Alexander S, Dramaix M,

Buekens P and Haelterman E. High perinatal mortality rate among immigrants in Brussels. Eur J Public Health. 2010 Oct 1;20(5):536–42.

Barona-Vilar C, López-Maside A, Bosch-Sánchez S,

Pérez-Panadés J, Melchor-Alós I, Mas-Pons R and Zurriaga O. Inequalities in Perinatal Mortality Rates Among Immigrant and Native Population in Spain, 2005–2008. J Immigr Minor Health. 2014 Feb;16(1):1–6.

Ekeus C, Cnattingius S, Essen B and Hjern A. Stillbirth

among foreign-born women in Sweden. Eur J Public Health. 2011 Dec 1;21(6):788–92.

Refbacks

  • There are currently no refbacks.