Are preterm birth and intra-uterine growth restriction more common in Western Australian children of immigrant backgrounds? A population based data linkage study.

BACKGROUND: To compare the prevalence of preterm birth, post term birth, intra-uterine growth restriction and distribution of Apgar scores in offspring of foreign-born women in Western Australia with that of their Australian-born non-Indigenous and Indigenous counterparts. METHODS: A population-based linked data study, involving 767,623 singleton births in Western Australia between 1980 and 2010 was undertaken. Neonatal outcomes included preterm birth, post term births, intra-uterine growth restriction (assessed using the proportion of optimal birth weight) and low Apgar scores. These were compared amongst foreign-born women from low, lower-middle, upper middle and high income countries and Australian-born non-Indigenous and Indigenous women over two different time periods using multinomial logistic regression adjusted for covariates. RESULTS: Compared with Australian born non-Indigenous women, foreign-born women from low income countries were at some increased risk of extreme preterm (aRRR 1.59, 95% CI 0.87, 2.89) and very early preterm (aRRR 1.63, 95% CI 0.92, 2.89) births during the period from 1980 to 1996. During the period from 1997 to 2010 they were also at some risk of extreme preterm (aRRR 1.42, 95% CI 0.98, 2.04) very early preterm (aRRR 1.34, 95% CI 1.11, 1.62) and post term birth (aRRR 1.93, 95% CI 0.99, 3.78). During this second time period, other adverse outcomes for children of foreign-born women from low income and middle income countries included increases in severe (aRRR 1.69, 95% CI 1.30, 2.20; aRRR 1.72, 95% CI 1.53, 1.93), moderate (aRRR 1.54, 95% CI 1.32, 1.81; aRRR 1.59, 95% CI 1.48, 1.70) and mild (aRRR 1.28, 95% CI 1.14, 1.43; aRRR 1.31, 95% CI 1.25, 1.38) IUGR compared to children of Australian-born non-Indigenous mothers. Uniformly higher risks of adverse outcomes were also demonstrated for infants of Indigenous mothers. CONCLUSIONS: Our findings illustrate the vulnerabilities of children born to foreign women from low and middle-income countries. The need for exploratory research examining mechanisms contributing to poorer birth outcomes following resettlement in a developed nation is highlighted. There is also a need to develop targeted interventions to improve outcomes for these women and their families.

Two cases of postmaturity-related perinatal mortality in non-local expectant mothers.

We present two cases of postmaturity-related perinatal mortality with delivery at 42 weeks 6 days' and 44 weeks' gestation, respectively. No cause beyond postmaturity was found. Neither induction of labour nor foetal monitoring had been performed despite these gestations going post 41 weeks because of a current 'social obstetrics' phenomenon--non-local expectant mothers coming to Hong Kong from mainland China for delivery.

Postterm delivery among African Americans, Mexican Americans and Whites in Chicago.

OBJECTIVES: The purpose of the present study was to examine the effect of individual-level and community-level risk factors on the postterm delivery rates of infants born to African-American, Mexican-American, and non-Latino White mothers; and to compare postterm delivery rates between these ethnic groups. DESIGN: This is a population-based study. METHODS: We performed stratified and multivariate logistic regression analyses on a linked dataset of 1992-1995 Illinois vital records, 1990 United States Census income data, and 1995 Chicago Department of Public Health information. Communities with one or more high-risk characteristics (low median family income or high rates of unemployment, homicide or lead poisoning) were classified as impoverished. RESULTS: In Chicago, African Americans (N = 85,978) had a postterm rate of 4.3/1,000 and Mexican Americans (N = 47,266) had a postterm rate of 3.6/1,000, compared to 2.3/1,000 for non-Latino Whites (N = 48,601); relative risk (ninety-five percent confidence interval) = 1.9 (1.5-2.3) and 1.6 (1.2-2.0), respectively. Maternal age, education, marital status, parity, and prenatal care usage were associated with ethnic group-specific postterm delivery rates. In a multivariate logistic regression model for non-impoverished mothers, the adjusted odds ratios of postterm delivery for African Americans and Mexican Americans were 1.0 (0.5-3.2) and 1.0 (0.6-1.7), respectively. CONCLUSIONS: We conclude that African Americans and Mexican Americans have greater postterm delivery rates than do Whites; however, commonly cited individual and community-level risk factors account for most of the disparity.