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      Birthweight of babies born to migrant mothers - What role do integration policies play?

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          Abstract

          Birthweights of babies born to migrant women are generally lower than those of babies born to native-born women. Favourable integration policies may improve migrants’ living conditions and contribute to higher birthweights. We aimed to explore associations between integration policies, captured by the Migrant Integration Policy Index (MIPEX), with offspring birthweight among migrants from various world regions. In this cross-country study we pooled 31 million term birth records between 1998 and 2014 from ten high-income countries: Australia, Belgium, Canada, Denmark, Finland, Japan, Norway, Spain, Sweden and United Kingdom (Scotland). Birthweight differences in grams (g) were analysed with regression analysis for aggregate data and random effects models.

          Proportion of births to migrant women varied from 2% in Japan to 28% in Australia. The MIPEX score was not associated with birthweight in most migrant groups, but was positively associated among native-born (mean birthweight difference associated with a 10-unit increase in MIPEX: 105 g; 95% CI: 24, 186). Birthweight among migrants was highest in the Nordic countries and lowest in Japan and Belgium. Migrants from a given origin had heavier newborns in countries where the mean birthweight of native-born was higher and vice versa. Mean birthweight differences between migrants from the same origin and the native-born varied substantially across destinations (70 g–285 g).

          Birthweight among migrants does not correlate with MIPEX scores. However, birthweight of migrant groups aligned better with that of the native-born in destination counties. Further studies may clarify which broader social policies support migrant women and have impacts on perinatal outcomes.

          Highlights

          • •

            Favourable migrant integration policies, as measured by the MIPEX, did not correlate with offspring birthweight among migrants.

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            However, the MIPEX correlated with birthweight among the offspring of native-born women.

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            Migrants' birthweights were higher in countries with high birthweights in the local population and vice versa.

          • •

            Birthweight among native-born seems to have a pull-effect on the birthweight of migrant groups.

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          On the importance--and the unimportance--of birthweight.

          Marsha Wilcox (2001)
          Birthweight is one of the most accessible and most misunderstood variables in epidemiology. A baby's weight at birth is strongly associated with mortality risk during the first year and, to a lesser degree, with developmental problems in childhood and the risk of various diseases in adulthood. Epidemiological analyses often regard birthweight as on the causal pathway to these health outcomes. Under this assumption of causality, birthweight is used to explain variations in infant mortality and later morbidity, and is also used as an intermediate health endpoint in itself. Evidence presented here suggests the link between birthweight and health outcomes may not be causal. Methods of analysis that assume causality are unreliable at best, and biased at worst. The category of 'low birthweight' in particular is uninformative and seldom justified. The main utility of the birthweight distribution is to provide an estimate of the proportion of small preterm births in a population (although even this requires special analytical methods). While the ordinary approaches to birthweight are not well grounded, the links between birthweight and a range of health outcomes may nonetheless reflect the workings of biological mechanisms with implications for human health.
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            Migration to western industrialised countries and perinatal health: a systematic review.

            A.J. Gagnon, M Zimbeck, J Zeitlin (2009)
            Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in western industrialised countries have consistently poorer perinatal health than receiving-country women. A systematic review of literature from Medline, Health Star, Embase and PsychInfo from 1995 to 2008 included studies of migrant women/infants related to pregnancy or birth. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not western and industrialised. Studies were assessed for quality, analysed descriptively and meta-analysed when possible. We identified 133 reports (>20,000,000 migrants), only 23 of which could be meta-analysed. Migrants were described primarily by geographic origin; other relevant aspects (e.g., time in country, language fluency) were rarely studied. Migrants' results for preterm birth, low birthweight and health-promoting behaviour were as good or better as those for receiving-country women in >or=50% of all studies. Meta-analyses found that Asian, North African and sub-Saharan African migrants were at greater risk of feto-infant mortality than 'majority' receiving populations, and Asian and sub-Saharan African migrants at greater risk of preterm birth. The migration literature is extensive, but the heterogeneity of the study designs and definitions of migrants limits the conclusions that can be drawn. Research that uses clear, specific migrant definitions, adjusts for relevant risk factors and includes other aspects of migrant experience is needed to confirm and understand these associations.
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              The likeness of fetal growth and newborn size across non-isolated populations in the INTERGROWTH-21st Project: the Fetal Growth Longitudinal Study and Newborn Cross-Sectional Study.

              Ann Lambert, Michael G. Gravett, Jose Villar … (2014)
              Large differences exist in size at birth and in rates of impaired fetal growth worldwide. The relative effects of nutrition, disease, the environment, and genetics on these differences are often debated. In clinical practice, various references are often used to assess fetal growth and newborn size across populations and ethnic origins, whereas international standards for assessing growth in infants and children have been established. In the INTERGROWTH-21(st) Project, our aim was to assess fetal growth and newborn size in eight geographically defined urban populations in which the health and nutrition needs of mothers were met and adequate antenatal care was provided. For this study, fetal growth and newborn size were measured in two INTERGROWTH-21(st) component studies using prespecified markers and the same methods, equipment, and selection criteria. In the Fetal Growth Longitudinal Study (FGLS), we studied educated, affluent, healthy women, with adequate nutritional status who were at low risk of intrauterine growth restriction. The primary markers of fetal growth were ultrasound measurements of fetal crown-rump length at less than 14 weeks and 0 days of gestation and fetal head circumference from 14 weeks and 0 days to 40 weeks and 0 days of gestation, and birthlength for newborn size. In the concomitant, population-based Newborn Cross-Sectional Study (NCSS), we measured birthlength in all newborn babies from the eight geographically defined urban populations with the same methods, instruments, and staff as in FGLS. From this large NCSS cohort, we selected an FGLS-like subpopulation to match FGLS with the same eligibility criteria. Between May 14, 2009, and Aug 2, 2013, we enrolled 4607 women in FGLS and 59 137 women in NCSS. From NCSS, 20 486 (34·6%) women met the FGLS eligibility criteria, and constituted the FGLS-like subpopulation. With variance component analysis, only between 1·9% and 3·5% of the total variability in crown-rump length, fetal head circumference, and newborn birthlength could be attributed to between-site differences. With standardised site effect analysis in 16 gestational age windows from 9 weeks and 0 days of gestation to birth for the three measures (128 comparisons), only one was marginally higher than 0·5 SD of the standardised site difference range. Sensitivity analyses, excluding individual populations in turn from the pooling of all-site centiles across gestational ages, showed no noticeable effect on the 3rd, 50th, and 97th centiles derived from the remaining populations. Our populations were consistent at birth with those in the WHO Multicentre Growth Reference Study (MGRS). The mean birthlength for term newborn babies in that study was 49·5 cm (SD 1·9), which was very similar to that in the FGLS cohort (49·4 cm [1·9]) and the NCSS derived FGLS-like subpopulation (49·3 cm [1·8]). Fetal growth and newborn length are similar across diverse geographical settings when mothers' nutritional and health needs are met, and environmental constraints on growth are low. The findings for birthlength are in strong agreement with those of the WHO MGRS. These results provide the conceptual frame to create international standards for growth from conception to newborn baby, which will extend the present infant to childhood WHO MGRS standards. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Ingvil K. Sørbye
                Siri Vangen
                Sol P. Juarez
                Francisco Bolumar
                Naho Morisaki
                Mika Gissler
                Anne-Marie N. Andersen
                Judith Racape
                Rhonda Small
                Rachael Wood
                Marcelo L. Urquia
                Journal
                Journal ID (nlm-ta): SSM Popul Health
                Journal ID (iso-abbrev): SSM Popul Health
                Title: SSM - Population Health
                Publisher: Elsevier
                ISSN (Electronic): 2352-8273
                Publication date PMC-release: 21 October 2019
                Publication date Collection: December 2019
                Publication date (Electronic): 21 October 2019
                Volume: 9
                Electronic Location Identifier: 100503
                Affiliations
                [a ]Norwegian Advisory Unit for Women's Health, Department of Obstetrics, Oslo University Hospital, Norway
                [b ]Department of Public Health Sciences, Stockholm University, Sweden
                [c ]Unit of Public Health, School of Medicine, University of Alcalá, Madrid, Spain
                [d ]City University of New York School of Public Health, New York, United States
                [e ]Department of Social Medicine, National Center for Child Health and Development, Japan
                [f ]THL National Institute for Health and Welfare, Information Services Department, Helsinki, Finland
                [g ]Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
                [h ]Faculty of Health Sciences, University of Copenhagen, Denmark
                [i ]École de Santé Publique, Faculté de Médecine, Université Libre de Bruxelles, Belgium
                [j ]Judith Lumley Centre, La Trobe University, Melbourne, Australia
                [k ]Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
                [l ]NHS National Services Scotland, Information Services Division, Edinburgh, Scotland, UK
                [m ]Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
                [n ]Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Ontario, Canada
                Author notes
                [∗ ]Corresponding author. Norwegian Advisory Unit for Women's health, Department of Obstetrics, Oslo University Hospital, 0027, Oslo, Norway. isorbye@ 123456ous-hf.no
                Article
                Publisher ID: S2352-8273(19)30197-1 Publisher ID: 100503
                DOI: 10.1016/j.ssmph.2019.100503
                PMC ID: 6978482
                PubMed ID: 31993489
                SO-VID: 065d0774-ef73-41a2-9c17-117c286a131e
                Copyright © © 2019 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 24 June 2019
                Date revision received : 16 October 2019
                Date accepted : 16 October 2019
                Categories
                Subject: Regular Article

                Keywords: migration,birthweight,pregnancy,mipex
                Data availability:
                Keywords: migration, birthweight, pregnancy, mipex

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