Exploring the hypothesis of differential care for African immigrant and native women in France with hypertensive disorders during pregnancy: a qualitative study.
OBJECTIVE
To analyse whether prenatal care trajectories among women with hypertensive disorders during pregnancy in France differ between immigrants from sub-Saharan Africa (SSA) and native French women.


METHODS
Qualitative interview study.


METHODS
Three public maternity units in the Paris region.


METHODS
Women born in SSA or in France of French parents and treated for hypertension or pre-eclampsia during their pregnancy.


METHODS
A sociologist conducted semi-structured in-depth interviews of 33 women during their postpartum hospitalisation and collected data from their medical files. n'vivo 10 (QSR International) was used for line-by-line coding of the transcriptions, to identify emerging themes. Strauss's concept of illness trajectories was then applied to these data.


METHODS
Themes derived from interviews.


RESULTS
Women reported during the interviews that the blood pressure measurement procedures used by hospital staff varied between the two groups, and their medical records supported this finding. Repeated urinary dipstick testing of proteinuria before laboratory testing was more frequent for African women, as was the failure to further test proteinuria levels requiring additional action. The two groups received similar standardised care after severe complications. Other findings showed that African women were less likely to rely on healthcare services.


CONCLUSIONS
These results suggest non-medically justified differential prenatal care between African and native women that may have helped delay the diagnosis of hypertension or pre-eclampsia. This study suggests hypotheses for further quantitative studies to explore the potential involvement of this differential care in the higher frequency of severe complications in this subgroup, concordantly reported in European countries hosting SSA migrants.


CONCLUSIONS
Differential prenatal care may delay diagnosis of pre-eclampsia among African compared with native French women.
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Inserm UMR 1153, Paris Descartes University, Paris, France.|Department of Obstetrics and Gynecology, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France.
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Sauvegrain
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Inserm UMR 1153, Paris Descartes University, Paris, France.|Notre Dame de Bon Secours Maternity Unit, Groupe Hospitalier Paris Saint-Joseph, DHU Risks in Pregnancy, Paris, France.
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Azria
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Inserm UMR 1153, Paris Descartes University, Paris, France.|Department of Obstetrics and Gynecology, Groupe Hospitalier de Rambouillet, Rambouillet, France.
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Chiesa-Dubruille
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Inserm UMR 1153, Paris Descartes University, Paris, France.
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Deneux-Tharaux
D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005602:France; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000208:ethnology / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology; D011225:Pre-Eclampsia / Q000208:ethnology / Q000523:psychology*; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology* / Q000706:statistics & numerical data; D011507:Proteinuria / Q000208:ethnology / Q000523:psychology; D036301:Qualitative Research; D055815:Young Adult
Differential care; health inequalities; migration; pre-eclampsia; pregnancy-induced hypertension; quality of health care