title: The role of prenatal care and social risk factors in the relationship between immigrant status and neonatal morbidity: a retrospective cohort study.
abstract: OBJECTIVE
  Literature evaluating association between neonatal morbidity and immigrant status presents contradictory results. Poorer compliance with prenatal care and greater social risk factors among immigrants could play roles as major confounding variables, thus explaining contradictions. We examined whether prenatal care and social risk factors are confounding variables in the relationship between immigrant status and neonatal morbidity.
  
  
  METHODS
  Retrospective cohort study: 231 pregnant African immigrant women were recruited from 2007-2010 in northern Spain. A Spanish population sample was obtained by simple random sampling at 1:3 ratio. Immigrant status (Spanish, Sub-Saharan and Northern African), prenatal care (Kessner Index adequate, intermediate or inadequate), and social risk factors were treated as independent variables. Low birth weight (LBW < 2500 grams) and preterm birth (< 37 weeks) were collected as neonatal morbidity variables. Crude and adjusted odds ratios (OR) were estimated by unconditional logistic regression with 95% confidence intervals (95% CI).
  
  
  RESULTS
  Positive associations between immigrant women and higher risk of neonatal morbidity were obtained. Crude OR for preterm births in Northern Africans with respect to nonimmigrants was 2.28 (95% CI: 1.04-5.00), and crude OR for LBW was 1.77 (95% CI: 0.74-4.22). However, after adjusting for prenatal care and social risk factors, associations became protective: adjusted OR for preterm birth = 0.42 (95% CI: 0.14-1.32); LBW = 0.48 (95% CI: 0.15-1.52). Poor compliance with prenatal care was the main independent risk factor associated with both preterm birth (adjusted OR inadequate care = 17.05; 95% CI: 3.92-74.24) and LBW (adjusted OR inadequate care = 6.25; 95% CI: 1.28-30.46). Social risk was an important independent risk factor associated with LBW (adjusted OR = 5.42; 95% CI: 1.58-18.62).
  
  
  CONCLUSIONS
  Prenatal care and social risk factors were major confounding variables in the relationship between immigrant status and neonatal morbidity.
authors: Departamento de Enfermería, Universidad de Cantabria, Santander, Spain.
authors: María
authors: M
authors: Paz-Zulueta
authors: Departamento de Salud Pública, Universidad de Cantabria, Santander, Spain; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors: Javier
authors: J
authors: Llorca
authors: Departamento de Enfermería, Universidad de Cantabria, Santander, Spain.
authors: Raquel
authors: R
authors: Sarabia-Lavín
authors: Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Epidemiology and Biostatistics Program, City University of New York (CUNY) School of Public Health at Hunter College, New York, United States of America; Departamento de Salud Pública, Universidad de Alcalá de Henares, Madrid, Spain.
authors: Francisco
authors: F
authors: Bolumar
authors: Gerencia de Atención Primaria, Servicio Cántabro de Salud, Santander, Spain.
authors: Luis
authors: L
authors: Rioja
authors: Gerencia de Atención Primaria, Servicio Cántabro de Salud, Santander, Spain.
authors: Abraham
authors: A
authors: Delgado
authors: Departamento de Salud Pública, Universidad de Cantabria, Santander, Spain; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
authors: Miguel
authors: M
authors: Santibáñez
mesh_terms: D000293:Adolescent; D000328:Adult; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D009017:Morbidity; D009035:Mothers / Q000523:psychology*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012931:Social Environment; D013030:Spain; D055815:Young Adult