Preterm disparities between foreign and Swedish born mothers depend on the method used to estimate gestational age. A Swedish population-based register study

PLoS One. 2021 Feb 22;16(2):e0247138. doi: 10.1371/journal.pone.0247138. eCollection 2021.

Abstract

This study aims to examine whether disparities in gestational age outcomes between foreign and Swedish-born mothers are contingent on the measure used to estimate gestational age and, if so, to identify which maternal factors are associated with the discrepancy. Using population register data, we studied all singleton live births in Sweden from 1992-2012 (n = 1,317,265). Multinomial logistic regression was performed to compare gestational age outcomes classified into very (<32 weeks) and late preterm (32-36 weeks), term and post-term derived from the last menstrual period (LMP) and ultrasound estimates in foreign- and Swedish-born women. Compared to Swedish-born women, foreign-born women had similar odds of very preterm birth (OR: 0.98 [95% CI: 0.98, 1.01]) and lower odds of moderately preterm birth (OR: 0.95 [95% CI: 0.92, 0.98]) based on ultrasound, while higher risks based on LMP (respectively, OR: 1.10 [95% CI: 1.07, 1.14] and 1.09 [95% CI: 1.06, 1.13]). Conclusions on disparities in gestational age-related outcomes by mother's country of origin depend on the method used to estimate gestational age. Except for very preterm, foreign-born women had a health advantage when gestational age is based on ultrasound, but a health disadvantage when based on LMP. Studies assessing disparities in very preterm birth by migration status are not affected by the estimation method but caution should be taken when interpreting disparities in moderately preterm and preterm birth rates.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Birth Weight
  • Emigrants and Immigrants / statistics & numerical data
  • Ethnicity / statistics & numerical data*
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Premature Birth / epidemiology*
  • Premature Birth / ethnology
  • Sweden

Grants and funding

Sol P. Juárez and Eleonora Mussino were supported by the Strategic Research Council of the Academy of Finland (TITA, Grant # 293103) and the Swedish Research Council (VR# #2018-01825); Sol P. Juárez and Anders Hjern were supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE grant #2012-01190 and #2016-07128). Marcelo L. Urquia holds a Canada Research Chair in Applied Population Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.