Paediatric and Perinatal Epidemiology
Volume 33, Issue 6, 2019, Pages 421-432

Adverse perinatal outcomes in immigrants: A ten-year population-based observational study and assessment of growth charts (Article)

Choi S.K.Y. , Henry A. , Hilder L. , Gordon A. , Jorm L. , Chambers G.M.*
  • a Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia, School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  • b School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia, Women’s and Children’s Health, St. George Hospital, Sydney, NSW, Australia
  • c Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia, School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  • d Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
  • e Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  • f Centre or Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia, School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

Abstract

Background: 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. © 2019 John Wiley & Sons Ltd

Author Keywords

Small for gestational age growth chart infant health perinatal mortality large for gestational age Immigration and emigration

Index Keywords

immigrant Australia India perinatal mortality human Asia Middle East controlled study premature labor male adverse outcome large for gestational age female Infant risk factor perinatal morbidity Africa observational study Apgar score population research Article adult small for date infant propensity score Infant Mortality cohort analysis Australian stillbirth Birth Weight risk reduction Philippines
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85071884342&doi=10.1111%2fppe.12583&partnerID=40&md5=0a6c8b141281db77290d790b427b0168
DOI: 10.1111/ppe.12583
ISSN: 02695022
Cited by: 1
Original Language: English