Maternal migration and infant mortality in extremely preterm births

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New study suggests maternal migration background impacts survival rates for infants born extremely preterm, underscoring the need to address disparities in birth outcomes and investigate potential connections between immigration status and perinatal health.

Maternal migration and infant mortality in extremely preterm births | Image Credit: © nowdog - © nowdog - stock.adobe.com.

Maternal migration and infant mortality in extremely preterm births | Image Credit: © nowdog - © nowdog - stock.adobe.com.

Maternal migration background impacts infant mortality among infants born extremely preterm, according to a recent study published in JAMA Network Open.

Takeaways

  1. The study suggests that maternal migration background has an impact on infant mortality among infants born extremely preterm, indicating a link between maternal demographic factors and neonatal outcomes.
  2. Health disparities in birth outcomes are associated with early childhood experiences, emphasizing the need to address disparities in healthcare access, provision, and behaviors to improve outcomes for infants, especially those born extremely preterm.
  3. Data indicates that patients from ethnic minority populations are less likely to receive high-quality treatments, and infant survival, particularly in neonatal intensive care units (NICUs), may be affected by disparities in access to life-sustaining therapies.
  4. The study suggests a potential connection between immigration status and perinatal outcomes, highlighting the importance of exploring the impact of ethnicity and migration background on neonatal health.
  5. The research findings reveal that infants born at 24 or 25 weeks of gestation to mothers with a migration background have a reduced risk of survival up to 1 week of life compared to those without a migration background.

Health inequities are often associated with early childhood experiences, highlighting the need to decrease disparities in birth outcomes. Potential factors behind these disparities include uneven health care access, different provision of health care, and differential health behaviors.

Data has indicated patients from ethnic minority populations are less likely to receive the best quality treatments. Infant survival is often dependent on neonatal intensive care units (NICUs), with many NICU deaths associated with withholding or withdrawing life-sustaining therapies.

Ethnicity has been associated with inequalities in perinatal outcomes, with a potential connection between immigration status and perinatal outcomes. However, more research is needed to determine this connection.

Investigators conducted a study to evaluate the association between maternal migration background and NICU admission and mortality. Live births from 24 weeks 0 days to 25 weeks 6 days between January 1, 2020, and December 31, 2017, in the Netherlands were evaluated.

Perinatal care was provided by general practitioners, midwives, obstetricians, and neonatologists and pediatricians. Data on maternal characteristics, pregnancy, delivery, and neonatal outcomes was obtained from the Dutch perinatal registry.

Maternal migration background exposures included no migration background, first-generation migrant, and second-generation migrant. NICU admission and mortality during the first year of life were the primary outcomes of the analysis.

Cofounders included maternal age at delivery, parity, disposable and household income, as well as infant sex, gestational age, multiple birth, and small for gestational age. Year of birth was also included as a cofounder to account for year-to-year variation in perinatal mortality.

There were 1405 livebirths included in the final analysis, of which 38.9% were to mothers with migration backgrounds. Of mothers with a migration background, 62.3% were first-generation migrants and 37.7% second-generation migrants. These mothers were more often in the bottom 2 income quintiles.

NICU admission was reported in 88.5% of infants. Mortality within the first week of life was reported in ¼, within the first month in 38.7%, and within the first year in 46.4%.

An increase in NICU admission was observed among infants born to mothers with a migration background compared to those without a migration background, at 89.7% vs 87.7%, respectively. However, this difference was not significant in adjusted models, with a risk ratio of 1.03.

Within the first week of life, mortality was observed among 21.8% of infants born to mothers with a migration background vs 28.2% of mothers born without a migration background. In the first month, these rates were 34.8% vs 41.2%, respectively. In the first year, they were 42.3% vs 49%, respectively. Similar results were found when adjusting for cofounding factors.

These results indicated migration background reduces the risk of survival up to 1 week of life in infants born at 24 or 25 weeks of gestation in the Netherlands. Investigators recommended additional studies to determine the factors behind this association.

Reference

Vidiella-Martin J, Been JV. Maternal migration background and mortality among infants born extremely preterm. JAMA Netw Open. 2023;6(12):e2347444. doi:10.1001/jamanetworkopen.2023.47444

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