title: Perinatal outcomes among immigrant mothers over two periods in a region of central Italy.
abstract: BACKGROUND
  The number of immigrants has increased in Italy in the last twenty years (7.2% of the Italian population), as have infants of foreign-born parents, but scanty evidence on perinatal outcomes is available. The aim of this study was to investigate whether infants of foreign-born mothers living in Italy have different odds of adverse perinatal outcomes compared to those of native-born mothers, and if such measures changed over two periods.
  
  
  METHODS
  The source of this area-based study was the regional hospital discharge database that records perinatal information on all births in the Lazio region. We analysed 296,739 singleton births born between 1996-1998 and 2006-2008. The exposure variable was the mother's region of birth. We considered five outcomes of perinatal health. We estimated crude and adjusted odds ratios and 95% confidence intervals (CIs) to evaluate the association between mother's region of birth and perinatal outcomes.
  
  
  RESULTS
  Perinatal outcomes were worse among infants of immigrant compared to Italian mothers, especially for sub-Saharan and west Africans, with the following crude ORs (in 1996-1998 and 2006-2008 respectively): 1.80 (95%CI:1.44-2.28) and 1.95 (95%CI:1.72-2.21) for very preterm births, and 1.32 (95%CI:1.16-1.50) and 1.32 (95%CI:1.25-1.39) for preterm births; 1.18 (95%CI:0.99-1.40) and 1.17 (95%CI:1.03-1.34) for a low Apgar score; 1.22 (95%CI:1.15-1.31) and 1.24 (95%CI:1.17-1.32) for the presence of respiratory diseases; 1.47 (95%CI:1.30-1.66) and 1.45 (95%CI:1.34-1.57) for the need for special or intensive neonatal care/in-hospital deaths; and 1.03 (95%CI:0.93-1.15) and 1.07 (95%CI:1.00-1.15) for congenital malformations. Overall, time did not affect the odds of outcomes differently between immigrant and Italian mothers and most outcomes improved over time among all infants. None of the risk factors considered confounded the associations.
  
  
  CONCLUSIONS
  Our findings suggest that migrant status is a risk factor for adverse perinatal health. Moreover, they suggest that perinatal outcomes improved over time in some immigrant women. This could be due to a general improvement in immigrants' health in the past decade, or it may indicate successful application of policies that increase accessibility to mother-child health services during the periconception and prenatal periods for legal and illegal immigrant women in Italy.
authors.affiliation: Laziosanità - Agency for Public Health of Lazio Region, Rome, Italy. cacciani@asplazio.it
authors.forename: Laura
authors.initials: L
authors.lastname: Cacciani
authors.forename: Simona
authors.initials: S
authors.lastname: Asole
authors.forename: Arianna
authors.initials: A
authors.lastname: Polo
authors.forename: Francesco
authors.initials: F
authors.lastname: Franco
authors.forename: Renato
authors.initials: R
authors.lastname: Lucchini
authors.forename: Mario
authors.initials: M
authors.lastname: De Curtis
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Lallo
authors.forename: Gabriella
authors.initials: G
authors.lastname: Guasticchi
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007558:Italy; D008875:Middle Aged; D009035:Mothers; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D055815:Young Adult