Journal of Epidemiology and Community Health
Volume 62, Issue 5, 2008, Pages 402-409

Do mother's education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect (Article)

Auger N.* , Luo Z.-C. , Platt R.W. , Daniel M.
  • a Unité Études et Analyses de l'Etat de Santé de la Population, Institut National de Santé Publique du Québec, Montréal, QC, Canada, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, QC, Canada, Institut National de Santé Publique du Québec, 190, boulevard Crémazie Est, Montréal, QC H2P 1E2, Canada
  • b Department of Obstetrics and Gynaecology, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
  • c Department of Epidemiology and Biostatistics, McGill University, Montréal, QC, Canada
  • d School of Health Sciences, University of South Australia, Adelaide, SA, Australia

Abstract

Introduction: The unresolved "epidemiological paradox" concerns the association between low socioeconomic status and unexpectedly favourable birth outcomes in foreign born mothers. The "healthy migrant" effect concerns the association between foreign born status per se and birth outcomes. The epidemiological paradox and healthy migrant effect were analysed for newborns in a favourable sociopolitical environment. Methods: 98 330 live births to mothers in Montreal, Canada from 1997 to 2001 were analysed. Mothers were categorised as foreign born versus Canadian born. Outcomes were: small for gestational age (SGA) birth; low birth weight (LBW) and preterm birth (PTB). Multilevel logistic regression was used to examine the interaction between maternal education and foreign born status, adjusting for covariates. Results: Not having a high school diploma was associated with LBW in Canadian (odds ratio (OR) 3.20; 95% CI 2.61 to 3.91) but not foreign born (OR 1.14; 95% CI 0.99 to 2.10) mothers and was more strongly associated with SGA birth in Canadian (OR 2.03; 95% CI 1.84 to 2.22) than in foreign born (OR 1.26; 95% CI 1.07 to 1.49) mothers. Foreign born status was associated with SGA birth (OR 1.37; 95% CI 1.28 to 1.47), LBW (OR 1.51; 95% CI 1.27 to 1.79) and PTB (OR 1.12; 95% CI 1.03 to 1.22) in university-educated mothers only. Conclusions: The epidemiological paradox associated with low educational attainment was present for SGA birth and LBW but not PTB. Foreign born status was associated with adverse birth outcomes in university-educated mothers, the opposite of the healthy migrant effect.

Author Keywords

[No Keywords available]

Index Keywords

educational status regression analysis high school multivariate logistic regression analysis correlation analysis human epidemiology mothers education controlled study socioeconomic status epidemiological data North America social status covariance Canada environmental factor female university newborn pregnancy covariance analysis Article low birth weight pregnancy outcome major clinical study mother adult migration small for date infant prematurity live birth newborn period maternal welfare Quebec [Canada] Montreal immigrant population
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-42549096615&doi=10.1136%2fjech.2007.064535&partnerID=40&md5=b29e73a57d8e2f24250a5e2ac32a3929
DOI: 10.1136/jech.2007.064535
ISSN: 0143005X
Cited by: 59
Original Language: English