The role of prenatal care and social risk factors in the relationship between immigrant status and neonatal morbidity: a retrospective cohort study

PLoS One. 2015 Mar 27;10(3):e0120765. doi: 10.1371/journal.pone.0120765. eCollection 2015.

Abstract

Background and aim: Literature evaluating association between neonatal morbidity and immigrant status presents contradictory results. Poorer compliance with prenatal care and greater social risk factors among immigrants could play roles as major confounding variables, thus explaining contradictions. We examined whether prenatal care and social risk factors are confounding variables in the relationship between immigrant status and neonatal morbidity.

Methods: Retrospective cohort study: 231 pregnant African immigrant women were recruited from 2007-2010 in northern Spain. A Spanish population sample was obtained by simple random sampling at 1:3 ratio. Immigrant status (Spanish, Sub-Saharan and Northern African), prenatal care (Kessner Index adequate, intermediate or inadequate), and social risk factors were treated as independent variables. Low birth weight (LBW < 2500 grams) and preterm birth (< 37 weeks) were collected as neonatal morbidity variables. Crude and adjusted odds ratios (OR) were estimated by unconditional logistic regression with 95% confidence intervals (95% CI).

Results: Positive associations between immigrant women and higher risk of neonatal morbidity were obtained. Crude OR for preterm births in Northern Africans with respect to nonimmigrants was 2.28 (95% CI: 1.04-5.00), and crude OR for LBW was 1.77 (95% CI: 0.74-4.22). However, after adjusting for prenatal care and social risk factors, associations became protective: adjusted OR for preterm birth = 0.42 (95% CI: 0.14-1.32); LBW = 0.48 (95% CI: 0.15-1.52). Poor compliance with prenatal care was the main independent risk factor associated with both preterm birth (adjusted OR inadequate care = 17.05; 95% CI: 3.92-74.24) and LBW (adjusted OR inadequate care = 6.25; 95% CI: 1.28-30.46). Social risk was an important independent risk factor associated with LBW (adjusted OR = 5.42; 95% CI: 1.58-18.62).

Conclusions: Prenatal care and social risk factors were major confounding variables in the relationship between immigrant status and neonatal morbidity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Emigrants and Immigrants / psychology*
  • Female
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature*
  • Morbidity*
  • Mothers / psychology*
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Pregnancy
  • Prenatal Care / psychology*
  • Prenatal Care / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • Social Environment*
  • Spain
  • Young Adult

Grants and funding

This work was partially supported by the secondary award for the best investigation protocol presented to the 12th edition of the National nursing research awards. In addition, Maria Paz-Zulueta was the recipient of a grant from IFIMAV for the best investigation protocol elaborated during the 5th course of methodology of investigation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.