Maternal and Child Health Journal
Volume 23, Issue 11, 2019, Pages 1525-1535

Adverse Pregnancy and Neonatal Outcomes Among Marshallese Women Living in the United States (Article)

Nembhard W.N.* , Ayers B.L. , Collins R.T. , Shan X. , Rabie N.Z. , Chang D. , Robbins J.M. , McElfish P.A.
  • a Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #820, Little Rock, AR 72205-7199, United States, Arkansas Children’s Research Institute, Little Rock, AR, United States
  • b College of Medicine, University of Arkansas for Medical Science, Fayetteville, AR, United States
  • c Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
  • d Arkansas Children’s Research Institute, Little Rock, AR, United States, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
  • e Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, HI, United States
  • f Arkansas Center for Health Improvement, University of Arkansas for Medical Sciences, Little Rock, AR, United States
  • g Arkansas Children’s Research Institute, Little Rock, AR, United States, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
  • h College of Medicine, University of Arkansas for Medical Science, Fayetteville, AR, United States

Abstract

Objective Despite heterogeneity among Pacific Islanders, most studies aggregate them regardless of origin. Thus, limited information is available about perinatal outcomes among various subgroups of Pacific Islanders in the United States, including immigrants from the Republic of the Marshall Islands. We sought to evaluate perinatal outcomes among Marshallese women. Methods We conducted a cross-sectional study of women with at least one singleton live birth between 1997 and 2013 in two Arkansas counties using birth certificate data from the Arkansas Department of Health. Unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated from modified Poisson regression models. Results Of the 91,662 singleton births in both counties during the study period, 2488 were to Marshallese women. In adjusted analyses, Marshallese women had higher prevalence of “other medical risk factors” (PR = 1.47; 95% CI 1.30, 1.65) than NH White women. Marshallese women had higher rates of precipitous labor and fetal distress during labor compared to NH White women (PR = 2.65; 95% CI 2.22, 3.17 and 1.89; 95% CI 1.62, 2.21, respectively). Marshallese were also more likely to have tocolysis (PR = 1.43; 95% CI 1.16, 1.76), forceps (PR = 1.68; 95% CI 1.16, 2.43) or vacuum (PR = 1.89; 95% CI 1.60, 2.22) used in delivery and cesarean section (PR = 1.13; 95% CI 1.01, 1.27). Marshallese infants had higher rates of anemia (PR = 3.10; 95% CI 2.01, 4.77), birth injury (PR = 2.13; 95% CI 1.50, 3.03), assisted ventilation < 30 min (PR = 2.11; 95% CI 1.64, 2.71), preterm birth (PR = 1.67; 95% CI 1.50, 1.83), and small-for-gestational age (PR = 1.25; 95% CI 1.12, 1.39) than NH White infants. Conclusions Marshallese women and infants had higher rates of adverse perinatal outcomes compared to their NH White counterparts. Additional studies are needed to determine if perinatal outcomes among the Marshallese differed from other Pacific Islander subgroups. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.

Author Keywords

Marshallese Pregnancy Marshall Islands Infant Pacific Islander Preterm birth Low birth weight

Index Keywords

[No Keywords available]
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068142339&doi=10.1007%2fs10995-019-02775-8&partnerID=40&md5=0b83a85b242f73f7bec32503269837a9
DOI: 10.1007/s10995-019-02775-8
ISSN: 10927875
Original Language: English