Cantarutti Anna, Arienti Francesca, Boroacchini Riccardo, Genovese Eleonora, Ornaghi Sara, Corrao Giovanni, Ghidini Alessandro, Locatelli Anna
Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milan, Italy.
Heliyon. 2024 Aug 28;10(17):e36958. doi: 10.1016/j.heliyon.2024.e36958. eCollection 2024 Sep 15.
To evaluate the association between maternal migration status and preterm birth, and whether a better adherence to antenatal care during pregnancy mitigates the risk of preterm birth.
Population-based cohort.
Administrative databases of the Lombardy region, Italy.
First singleton births of women aged 15-55 years at 22-42 gestational weeks, between 2016 and 2021.
Assessed the risk of preterm birth (<37 weeks).
A multivariable logistic regression mediation model calculated the mediation effect of adherence to antenatal care in the association between maternal migrant status and preterm birth and the residual effect not mediated by it. Analyses were adjusted for the socio-demographic and pregnant characteristics of the women.
Of 349,753 births in the cohort, Italian nationality accounted for 71 %; 28.4 % were documented migrants and 0.4 % undocumented migrants. Among them, 5.3 %, 6.4 %, and 9.3 % had a preterm birth, respectively. Using deliveries of Italian citizens as referent, migrants had a significantly increased risk of preterm birth (adjusted relative risk: 1.22, 95 % confidence interval: 1.18-1.27). Adherence to antenatal care mediated the 62 % of such risk. We have calculated that adherence to antenatal pathways set to the highest level for the whole population could lead to a 37 % reduction in preterm birth risk.
Part of the excess of preterm birth among documented and undocumented migrants in Italy can be explained by a lack of adherence to the antenatal care path despite equal access to National Health care. The adherence of all pregnant women to antenatal care would reduce the risk of preterm birth by about one-third.
评估母亲的移民身份与早产之间的关联，以及孕期更好地坚持产前护理是否能降低早产风险。
基于人群的队列研究。
意大利伦巴第地区的行政数据库。
2016年至2021年期间，年龄在15 - 55岁、孕周为22 - 42周的首次单胎分娩妇女。
评估早产（<37周）风险。
多变量逻辑回归中介模型计算了产前护理依从性在母亲移民身份与早产关联中的中介效应以及未由其介导的残余效应。分析针对女性的社会人口学和怀孕特征进行了调整。
队列中的349,753例分娩中，意大利国籍占71%；有记录的移民占28.4%，无记录的移民占0.4%。其中，早产率分别为5.3%、6.4%和9.3%。以意大利公民分娩作为对照，移民的早产风险显著增加（调整后的相对风险：1.22，95%置信区间：1.18 - 1.27）。产前护理依从性介导了该风险的62%。我们计算得出，将整个人群的产前护理路径依从性设定为最高水平可使早产风险降低37%。
尽管在获得国家医疗保健方面机会均等，但意大利有记录和无记录移民中早产率过高的部分原因可解释为缺乏对产前护理路径的依从性。所有孕妇坚持产前护理将使早产风险降低约三分之一。
