Comparative study of changes in maternal and perinatal morbidity inequalities among migrant and native women over time, between 2008 and 2014 in France.

BACKGROUND

An increased risk of severe maternal morbidity and mortality has been described in migrant women, particularly in those born in sub-Saharan Africa. The mechanisms in question are poorly identified and rarely studied specifically.

OBJECTIVE

To compare changes in maternal and perinatal morbidity inequalities among migrant and native women over time, between 2008 and 2014.

MATERIAL AND METHOD: A retrospective, single-centre study carried out at the Maternity Unit of the University of Caen Hospital in France. All women who gave birth in 2008 or 2014 were included. Twin pregnancies and delivery before reaching 22 weeks of pregnancy were excluded. Pre-pregnancy characteristics and maternal and perinatal morbidities were collected from the university hospital's medical and administrative database. We compared the maternal and perinatal morbidity in 2008 and 2014 of women born in France to the morbidity of women born abroad. Secondly, we compared these migrant women between 2008 and 2014 to see if changes in the characteristics of migrant women were associated with a change in the type of maternal and perinatal complications.

RESULTS

Of the 3,038 and 3,001 women included in 2008 and 2014, respectively, 272 (9.0 %) and 385 (12.8 %) women were migrants. Compared to women born in France, we found two times more severe postpartum hemorrhages in women born in sub-Saharan Africa (aOR = 2.1[1.1-3.9]) and a significant increase in the risk of gestational diabetes in women born in North Africa (aOR = 1.9[1.2-2.9]). We found a significant increase in the risk of severe postpartum hemorrhage (aOR = 2.1[1.5-3.0]) and gestational diabetes (aOR = 3.0[2.5-3.7]) in 2014 compared to 2008. We did not find a significant difference in perinatal morbidity between 2008 and 2014.

CONCLUSION

We noted a significant increase in the risk of severe postpartum hemorrhage in women born in sub-Saharan Africa and gestational diabetes in women born in North Africa compared to those born in France, and these risks increase in 2014 relative to 2008.