Effect of access to antenatal care on risk of preterm birth among migrant women in Italy: A population-based cohort study
Anna Cantarutti,
Francesca Arienti,
Riccardo Boroacchini,
Eleonora Genovese,
Sara Ornaghi,
Giovanni Corrao,
Alessandro Ghidini,
Anna Locatelli
Affiliations
Anna Cantarutti
Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Corresponding author. Department of Statistics and Quantitative Methods Division of Biostatistics Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, U7, 20126, Milan, Italy.
Francesca Arienti
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milan, Italy
Riccardo Boroacchini
Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
Eleonora Genovese
Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
Sara Ornaghi
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milan, Italy
Giovanni Corrao
Laboratory of Healthcare Research and Pharmacoepidemiology, Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
Alessandro Ghidini
Antenatal Testing Center Alexandria Hospital, Alexandria, VA, USA; Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, D.C., USA
Anna Locatelli
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milan, Italy
Objective: To evaluate the association between maternal migration status and preterm birth, and whether a better adherence to antenatal care during pregnancy mitigates the risk of preterm birth. Design: Population-based cohort. Setting: Administrative databases of the Lombardy region, Italy. Population: First singleton births of women aged 15–55 years at 22–42 gestational weeks, between 2016 and 2021. Methods: Assessed the risk of preterm birth (<37 weeks). Main outcome measures: A multivariable logistic regression mediation model calculated the mediation effect of adherence to antenatal care in the association between maternal migrant status and preterm birth and the residual effect not mediated by it. Analyses were adjusted for the socio-demographic and pregnant characteristics of the women. Results: Of 349,753 births in the cohort, Italian nationality accounted for 71 %; 28.4 % were documented migrants and 0.4 % undocumented migrants. Among them, 5.3 %, 6.4 %, and 9.3 % had a preterm birth, respectively. Using deliveries of Italian citizens as referent, migrants had a significantly increased risk of preterm birth (adjusted relative risk: 1.22, 95 % confidence interval: 1.18–1.27). Adherence to antenatal care mediated the 62 % of such risk. We have calculated that adherence to antenatal pathways set to the highest level for the whole population could lead to a 37 % reduction in preterm birth risk. Conclusion: Part of the excess of preterm birth among documented and undocumented migrants in Italy can be explained by a lack of adherence to the antenatal care path despite equal access to National Health care. The adherence of all pregnant women to antenatal care would reduce the risk of preterm birth by about one-third.
