Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.
Department of Obstetrics and Gynaecology, Caen Hospital, Caen, France.
BJOG. 2022 Sep;129(10):1762-1771. doi: 10.1111/1471-0528.17124. Epub 2022 Mar 4.
To assess the risk of severe maternal outcomes among migrant women, considering both their legal status and birthplace; in Europe, migrant women, especially from sub-Saharan Africa, have higher risks of adverse maternal outcomes compared with non-migrants and legal status, a component of migrant condition, may be an important, and potentially actionable, risk factor.
Prospective cohort study.
Four maternity units around Paris in 2010-12.
A total of 9599 women with singleton pregnancies.
Legal status was categorised in four groups: reference group of non-migrant native Frenchwomen, legal migrants with French or European citizenship, other legal migrants with non-European citizenship, and undocumented migrants. The risk of severe maternal morbidity was assessed with multivariable logistic regression models according to women's legal status and birthplace.
Binary composite criterion of severe maternal morbidity.
Undocumented migrants had resided for less time in France, experienced social isolation, linguistic barriers and poor housing conditions more frequently and had a pre-pregnancy medical history at lower risk than other migrants. The multivariable analysis showed that they had a higher risk of severe maternal morbidity than non-migrants (33/715 [4.6%] versus 129/4523 [2.9%]; adjusted odds ratio [aOR] 1.68, 95% CI 1.12-2.53). This increased risk was significant for undocumented women from sub-Saharan Africa (18/308 [5.8%] versus 129/4523 [2.9%]; aOR 2.26, 95% CI 1.30-3.91), and not for those born elsewhere (15/407 [3.7%] versus 129/4523 [2.9%]; aOR 1.44, 95% CI 0.82-2.53).
Undocumented migrants are the migrant subgroup at highest risk of severe maternal morbidity, whereas the prevalence of risk factors does not appear to be higher in this subgroup. This finding suggests that their interaction with maternity care services may be sub-optimal.
Undocumented migrants, especially those born in sub-Saharan Africa, have the highest risk of Severe Maternal Morbidity.
评估移民妇女的严重产妇结局风险，同时考虑其法律地位和出生地；在欧洲，与非移民相比，移民妇女，尤其是来自撒哈拉以南非洲的移民妇女，其不良产妇结局的风险更高，而移民状况的一个组成部分，即法律地位，可能是一个重要的、潜在可操作的风险因素。
前瞻性队列研究。
2010 年至 2012 年巴黎周边的四个产科单位。
共 9599 名单胎妊娠妇女。
法律地位分为四组：非移民原籍法国妇女的参考组、拥有法国或欧洲公民身份的合法移民、拥有非欧洲公民身份的其他合法移民和无证移民。根据妇女的法律地位和出生地，使用多变量逻辑回归模型评估严重产妇发病率的风险。
严重产妇发病率的二进制复合标准。
无证移民在法国的居住时间较短，更频繁地经历社会孤立、语言障碍和住房条件差，且孕前病史风险较低。多变量分析显示，与非移民相比，她们发生严重产妇发病率的风险更高（33/715[4.6%]与 129/4523[2.9%]；调整后的优势比[aOR]1.68，95%CI1.12-2.53）。这种风险增加在来自撒哈拉以南非洲的无证移民中更为显著（18/308[5.8%]与 129/4523[2.9%]；aOR2.26，95%CI1.30-3.91），而在其他地方出生的无证移民中则不显著（15/407[3.7%]与 129/4523[2.9%]；aOR1.44，95%CI0.82-2.53）。
无证移民是严重产妇发病率风险最高的移民亚组，而这一组的风险因素患病率似乎并没有更高。这一发现表明，他们与产妇保健服务的相互作用可能不理想。
无证移民，尤其是那些出生在撒哈拉以南非洲的移民，发生严重产妇发病率的风险最高。
