Research centre in Health Policies and Health Systems, Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Bruxelles, Belgium.
Department of social and preventive medicine , Ecole de Santé Publique, Université de Montréal, Montréal, Québec, H3N 1X9, Canada.
BMC Pregnancy Childbirth. 2018 Oct 26;18(1):422. doi: 10.1186/s12884-018-2043-3.
Understanding and tackling perinatal health inequities in industrialized countries requires analysing the socioeconomic determinants of adverse pregnancy outcomes among immigrant populations. Studies show that among certain migrant groups, education is not associated with adverse pregnancy outcomes. We aim to extend this analysis to further dimensions of socioeconomic status (SES) and to other settings. The objective of this study is to identify sociodemographic characteristics associated with adverse pregnancy outcomes, according to the origin of mothers residing in Brussels.
We analysed all singleton live births in Brussels between 2005 and 2010 (n = 97,844). The data arise from the linkage between three administrative databases. Four groups of women were included according to their place of birth: Belgium, EU, North Africa, and Sub-Saharan Africa. For each group, logistic regression was carried out to estimate the odds ratios of low birthweight (LBW) and small for gestational age (SGA) according to SES indicators (household income, maternal employment status, maternal education) and single parenthood.
Three key findings emerge from this study: 1) 25% of children were born into a household under the poverty threshold. This proportion was much higher for mothers born outside of the EU. 2) For North African immigrants, SES indicators didn't influence the pregnancy outcomes, whereas their risk of LBW increased with single parenthood. 3) For Sub-Saharan Africans the risk of LBW increased with low household income.
In a region where immigrant mothers are at high poverty risk, we observe a classic social gradient in perinatal outcomes only for mothers born in Belgium or the EU. In the other groups, SES influences perinatal outcomes less systematically. To develop interventions to reduce inequities from birth, it's important to identify the determinants of perinatal health among immigrants and to understand the underlying mechanisms in different contexts.
要了解和解决工业化国家围产期健康的不平等问题，需要分析移民人群中不良妊娠结局的社会经济决定因素。研究表明，在某些移民群体中，教育与不良妊娠结局无关。我们旨在将这一分析扩展到社会经济地位（SES）的其他维度，并扩展到其他环境。本研究的目的是根据居住在布鲁塞尔的母亲的原籍国，确定与不良妊娠结局相关的社会人口特征。
我们分析了 2005 年至 2010 年间布鲁塞尔所有单胎活产儿（n=97844）。这些数据来源于三个行政数据库的链接。根据出生地，将妇女分为四组：比利时、欧盟、北非和撒哈拉以南非洲。对于每个组，进行逻辑回归，以根据 SES 指标（家庭收入、母亲就业状况、母亲教育程度）和单亲家庭状况，估计低出生体重（LBW）和小于胎龄儿（SGA）的比值比。
本研究有三个主要发现：1）25%的儿童出生在贫困线以下的家庭。对于出生在欧盟以外的母亲来说，这一比例要高得多。2）对于北非移民来说，SES 指标并不影响妊娠结局，而单亲家庭增加了 LBW 的风险。3）对于撒哈拉以南非洲人来说，LBW 的风险随着家庭收入的降低而增加。
在一个移民母亲处于高贫困风险的地区，我们只观察到比利时或欧盟出生的母亲的围产期结局存在典型的社会梯度。在其他群体中，SES 对围产期结局的影响不那么系统。为了制定减少出生不平等的干预措施，必须确定移民围产期健康的决定因素，并了解不同背景下的潜在机制。
