title: Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study.
abstract: BACKGROUND
  One in four Australians is born overseas and 47% are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ.
  
  
  METHODS
  Data from one Sydney hospital (2012-2013) of all births recorded in the ObstetriX database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas.
  
  
  RESULTS
  Women born in Australia were younger, more likely to be primiparous (28.6 v 27.5%), be obese (32.0% v 21.4%), smoke (19.7 % v 3.0%), have an epidural (26.2% v 20.2%) and were less likely to have gestational diabetes mellitus (GDM) (6.8% v 13.7% when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95% CI 1.14-3.0).
  
  
  CONCLUSIONS
  There are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.
authors.affiliation: School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. h.dahlen@westernsydney.edu.au.
authors.forename: Hannah Grace
authors.initials: HG
authors.lastname: Dahlen
authors.affiliation: School of Psychiatry, Clinical Director, St John of God Raphael Centre, Medicine, University of New South Wales, 36-38 First Avenue, Blacktown, NSW, 2148, Australia. bryanne.barnett@sjog.org.au.|St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia. bryanne.barnett@sjog.org.au.
authors.forename: Bryanne
authors.initials: B
authors.lastname: Barnett
authors.affiliation: St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia. Jane.Kohlhoff@swsahs.nsw.gov.|Karitane, P.O. Box 241, Villawood, 2163 NSW, Australia. Jane.Kohlhoff@swsahs.nsw.gov.
authors.forename: Jane
authors.initials: J
authors.lastname: Kohlhoff
authors.affiliation: St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia. blacktown.manager@sjog.org.au.
authors.forename: Maya Elizabeth
authors.initials: ME
authors.lastname: Drum
authors.affiliation: Clinical Midwifery Consultant, Blacktown Hospital, Blacktown, Australia. Ana.Munoz@health.nsw.gov.au.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Munoz
authors.affiliation: School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. c.thornton@westernsydney.edu.au.
authors.forename: Charlene
authors.initials: C
authors.lastname: Thornton
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000208:ethnology; D001315:Australia / Q000453:epidemiology; D001942:Breast Feeding / Q000523:psychology; D002681:China / Q000208:ethnology; D016640:Diabetes, Gestational / Q000208:ethnology*; D005260:Female; D005367:Fiji / Q000208:ethnology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000208:ethnology*; D007194:India / Q000208:ethnology; D001523:Mental Disorders / Q000208:ethnology* / Q000523:psychology; D008875:Middle Aged; D009520:New Zealand / Q000208:ethnology; D010154:Pakistan / Q000208:ethnology; D010298:Parity; D010679:Philippines / Q000208:ethnology; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology; D013397:Sudan / Q000208:ethnology; D055815:Young Adult