Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: an analysis of linked national data from 2006 to 2012

Abstract

BackgroundRisks of adverse birth outcomes in England and Wales are relatively low but vary across ethnic groups. We aimed to explore the role of mother’s country of birth on birth outcomes across ethnic groups using a large population-based linked data set.MethodsWe used a cohort of 4.6 million singleton live births in England and Wales to estimate relative risks of neonatal mortality, infant mortality and preterm birth, and differences in birth weight, comparing infants of UK-born mothers to infants whose mothers were born in their countries or regions of ethnic origin, or elsewhere.ResultsThe crude neonatal and infant death risks were 2.1 and 3.2 per 1000, respectively, the crude preterm birth risk was 5.6% and the crude mean birth weight was 3.36 kg. Pooling across all ethnic groups, infants of mothers born in their countries or regions of ethnic origin had lower adjusted risks of death and preterm birth, and higher gestational age-adjusted mean birth weights than those of UK-born mothers. White British infants of non-UK-born mothers had slightly lower gestational age-adjusted mean birth weights than White British infants of UK-born mothers (mean difference −3 g, 95% CI −5 g to −0.3 g). Pakistani infants of Pakistan-born mothers had lower adjusted risks of neonatal death (adjusted risk ratio (aRR) 0.84, 95% CI 0.72 to 0.98), infant death (aRR 0.84, 95% CI 0.75 to 0.94) and preterm birth (aRR 0.85, 95% CI 0.82 to 0.88) than Pakistani infants of UK-born Pakistani mothers. Indian infants of India-born mothers had lower adjusted preterm birth risk (aRR 0.91, 95% CI 0.87 to 0.96) than Indian infants of UK-born Indian mothers. There was no evidence of a difference by mother’s country of birth in risk of birth outcomes among Black infants, except Black Caribbean infants of mothers born in neither the UK nor their region of origin, who had higher neonatal death risks (aRR 1.71, 95% CI 1.06 to 2.76).ConclusionThis study highlights evidence of better birth outcomes among UK-born infants of non-UK-born minority ethnic group mothers, and could inform the design of future interventions to reduce the risks of adverse birth outcomes through improved targeting of at-risk groups.

Beyond the healthy immigrant paradox: decomposing differences in birthweight among immigrants in Spain

“…The main outcome variable was the registered birthweight, from the Spanish vital statistics data, for the period 2017–2017. The mean birthweight of infants born to immigrant mothers from different origins is a valid indicator of perinatal health, as well as a strong predictor of mid- and long-term health-related outcomes as has been shown in previous research [ 13 , 24 , 38 ]. It should be noted that there is a large correlation (point-biserial correlation coefficient: − 0.58, 95% CI: − 0.58 to − 0.58) between the mean birthweight at term and low birthweight (< 2500 g).…”

Regional differences in short stature in England between 2006 and 2019: A cross-sectional analysis from the National Child Measurement Programme

“…Short stature is more common in boys than girls in LMICs, and it has been postulated that this is due to higher rates of adverse birth outcomes and increased vulnerability to infection and other morbidity during infancy in boys [ 27 , 28 ]. These data might suggest that this is not a reasonable explanation for sex differences in referral patterns in the UK setting, as the incidence of adverse birth outcomes and childhood infections are higher for boys in the UK [ 29 , 30 ]. It should be noted that the use of UK90 growth references means that rates of short stature in girls and boys will be slightly different to those calculated using WHO standards, which are used in most of the international literature.…”

A Systematic Review and Meta-Analysis of the Risk of Stillbirth, Perinatal and Neonatal Mortality in Immigrant Women

“…The main characteristics of the selected studies have been outlined in Table 1 . The studies were conducted in Europe ( n = 37; Spain [ 23 , 33 ], Finland [ 25 , 34 ], Israel [ 9 , 15 ], Turkey [ 22 , 24 , 35 – 38 ], Sweden [ 12 , 13 , 39 , 40 ], Norway [ 16 , 19 , 41 – 45 ], Belgium [ 17 , 18 , 45 , 46 ], United Kingdom [ 45 , 47 ], Netherlands [ 20 , 45 ], Denmark [ 45 , 48 ], Switzerland [ 45 ], Austria [ 45 ], Germany [ 45 ] and Italy [ 49 ]), America ( n = 8; Canada [ 21 , 26 , 50 ], USA [ 51 – 53 ] and Argentina [ 4 , 54 ]), Australia ( n = 5) [ 8 , 10 , 11 , 14 , 55 ]), and Taiwan ( n = 1) [ 56 , 57 ]. The results of quality appraisals of the included studies have been summarized in Supplementary Tables S1, S2 .…”

“…A total of 17 studies [ 4 , 8 , 10 , 11 , 26 , 33 , 34 , 42 , 43 , 46 , 47 , 50 – 54 , 56 ] reported the perinatal mortality among 4,399 out of 487,508 immigrant women and 30,838 out of 3,859,199 native-origin women. However, heterogeneity (I-squared = 87.1%) without publication bias (Harbord test p value = 0.340) was found across the studies.…”