Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway.
Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Ann Glob Health. 2022 Jun 28;88(1):44. doi: 10.5334/aogh.3591. eCollection 2022.
Disparities in health outcomes between immigrant and native-origin populations, particularly pregnant women, pose significant challenges to healthcare systems. The aim of this systematic-review and meta-analysis was to investigate the risk of adverse pregnancy outcomes among immigrant-women compared to native-origin women in the host country.
PubMed (including MEDLINE), Scopus, and Web of Science were searched to retrieve studies published in English language up to September 2020. All observational studies examining the prevalence of at least one of the short-term single pregnancy outcomes for immigrants who crossed international borders compared to native-origin pregnant population were included. The meta-prop method was used for the pooled-estimation of adverse pregnancy-outcomes' prevalence. For pool-effect estimates, the association between the immigration-status and outcomes of interest, the random-effects model was applied using the model described by DerSimonian and Laird. I statistic was used to assess heterogeneity. The publication bias was assessed using the Harbord-test. Meta-regression was performed to explore the effect of geographical region as the heterogeneity source.
This review involved 11 320 674 pregnant women with an immigration-background and 56 102 698 pregnant women as the native-origin population. The risk of emergency cesarean section (Pooled-OR = 1.1, 95%CI = 1.0-1.2), shoulder dystocia (Pooled-OR = 1.1, 95%CI = 1.0-1.3), gestational diabetes mellites (Pooled-OR = 1.4, 95%CI = 1.2-1.6), small for gestational age (Pooled-OR=1.3, 95%CI = 1.1-0.4), 5-min Apgar less than 7 (Pooled-OR = 1.2, 95%CI = 1.0-1.3) and oligohydramnios (Pooled-OR = 1.8, 95%CI = 1.0-3.3) in the immigrant women were significantly higher than those with the native origin background. The immigrant women had a lower risk of labor induction (Pooled-OR = 0.8, 95%CI = 0.7-0.8), pregnancy induced hypertension (Pooled-OR = 0.6, 95%CI = 0.5-0.7) preeclampsia (Pooled-OR = 0.7, 95%CI = 0.6-0.8), macrosomia (Pooled-OR = 0.8, 95%CI = 0.7-0.9) and large for gestational age (Pooled-OR = 0.8, 95%CI = 0.7-0.8). Also, the risk of total and primary cesarean section, instrumental-delivery, preterm-birth, and birth-trauma were similar in both groups. According to meta-regression analyses, the reported ORs were not influenced by the country of origin.
The relationship between the immigration status and adverse perinatal outcomes indicated a heterogenous pattern, but the immigrant women were at an increased risk of some important adverse pregnancy outcomes. Population-based studies with a focus on the various aspects of this phenomena are required to explain the source of these heterogenicities.
移民和本土出生人口之间的健康结果差异，尤其是孕妇，对医疗保健系统构成了重大挑战。本系统评价和荟萃分析的目的是调查与本土出生妇女相比，移民妇女在东道国的不良妊娠结局风险。
检索了 2020 年 9 月前在英文期刊上发表的研究，包括 PubMed（包括 MEDLINE）、Scopus 和 Web of Science。纳入了比较跨越国际边界的移民妇女和本土出生孕妇至少有一种短期单一妊娠结局的患病率的所有观察性研究。使用 meta-prop 方法对不良妊娠结局的患病率进行汇总估计。对于合并效应估计，采用描述 DerSimonian 和 Laird 的随机效应模型来应用移民状况与感兴趣结局之间的相关性。使用 I 统计量来评估异质性。使用 Harbord 检验评估发表偏倚。进行了荟萃回归分析，以探讨地理区域作为异质性来源的影响。
本综述共纳入了 11320674 名有移民背景的孕妇和 56102698 名本土出生的孕妇。急诊剖宫产（合并 OR=1.1，95%CI=1.0-1.2）、肩难产（合并 OR=1.1，95%CI=1.0-1.3）、妊娠期糖尿病（合并 OR=1.4，95%CI=1.2-1.6）、胎儿生长受限（合并 OR=1.3，95%CI=1.1-0.4）、5 分钟 Apgar 评分<7（合并 OR=1.2，95%CI=1.0-1.3）和羊水过少（合并 OR=1.8，95%CI=1.0-3.3）的风险显著高于本土出生背景的孕妇。移民妇女的分娩诱导（合并 OR=0.8，95%CI=0.7-0.8）、妊娠高血压（合并 OR=0.6，95%CI=0.5-0.7）、子痫前期（合并 OR=0.7，95%CI=0.6-0.8）、巨大儿（合并 OR=0.8，95%CI=0.7-0.9）和大于胎龄儿（合并 OR=0.8，95%CI=0.7-0.8）的风险较低。此外，两组的总剖宫产率和初次剖宫产率、器械分娩率、早产率和分娩创伤率均相似。根据荟萃回归分析，报告的 OR 不受原籍国的影响。
移民身份与不良围产期结局之间的关系表明存在异质性模式，但移民妇女某些重要不良妊娠结局的风险增加。需要进行以人群为基础的研究，重点关注这一现象的各个方面，以解释这些异质性的来源。
