Salud perinatal en población autóctona e inmigrante

Resumen

BACKGROUND: Spain has become one of the main destinations for migrant women coming from developing countries. Births from these foreign mothers have increased during the last decade, being delivery the principal cause of hospitalization. Migratory processes can have important implications for the health of women and their offspring, so it is essential to identify potential inequities with the native population in the access to health care as well as differences in the quality of care and in the reproductive outcomes. OBJECTIVES: To assess the quality of data available in some sanitary and administrative registers potentially useful for comparison of perinatal health indicators in populations from different geographical origin. To compare some of the main perinatal health indicators in native population and in the main immigrant groups living in Spain. METHODOLOGY: 1) Calculation of a prenatal care index to compare the level of care received during pregnancy by Spanish and immigrant women from different geographical origins attended over the past decade in the hospital of El Ejido. Analysis of the association between the level of prenatal care and the reproductive outcomes by means of logistic regression. 2) Comparison of the completeness and quality of perinatal mortality data available in the Vital Statistics register and in the Perinatal Mortality Register of Comunitat Valenciana. Subsequently, comparisons of the perinatal mortality rates and its components according to the geographic origin of the women were performed. 3) Comparison of the completeness and quality of births data available in the Vital Statistics Register and in the Registers of congenital metabolic diseases of Catalonia and Comunitat Valenciana. Using both autonomic registers, prevalences of prematurity and low birthweight were compared in native and immigrant population from different origins. We also performed crude and adjusted logistic regression analysis to estimate the risk of prematurity or low birthweight by geographic origin of the women. 4) With data from both regional registers, we perform a comparison between native and immigrant mothers regarding the rates of caesarean section and the initiation of breastfeeding in hospital. Regression logistic analyses were performed to estimate the risk of caesarean section and the risk of not breastfeeding by geographical origin. RESULTS: 1) Inadequate prenatal care is more frequent for Latin-American, Maghrebian, Eastern European and Sub-Saharan immigrants than for Spanish. 2) The Perinatal Mortality Register of Comunitat Valenciana seems a more reliable source for the calculation of perinatal mortality rates than the Vital Statistics Register. According to data of this register, all immigrant groups have higher perinatal mortality rates than native population, especially high for Eastern European and Sub-Saharan women. 3) The Registers of congenital metabolic diseases from Catalonia and Comunitat Valenciana are more reliable sources to calculate prevalences of prematurity and low birthweight than the Vital Statistics Register. According to both regional sources, immigrants from Eastern Europe and Sub-Saharan Africa have a higher risk of having very preterm or very low weight neonates than native women. North Africans and LatinAmerican women, by contrast, have no increased risk of prematurity or low birth weight as compared with Spanish. 4) Both registers further indicate that the risk of caesarean section in public hospitals is higher for Latin-American than for Spanish women and less for the other immigrant groups. This risk is higher in private than in public hospitals for all women, although the increase in the risk is greater for immigrants than for natives. Finally, the risk of not introducing breastfeeding in the hospital is higher for Spanish than for immigrant mothers, exception made of women from northern Asia who started mostly bottle feeding, being their risk of not initiating breastfeeding almost five times that of native mothers. CONCLUSIONS: Regional sanitary registers in Spain are more reliable than the Vital Statistics Register for comparison of perinatal health indicators in native and immigrant population. Such registers also allow for the comparison of some quality care indicators in both populations. According to these registers, all immigrant groups living in Spain have higher perinatal mortality rates than natives, with Eastern-European and SubSaharan women having the highest rates and also a higher risk of delivering very preterm and very low birthweight children than Spanish. There are also differences between native and immigrants in some quality care indicators, such as the higher proportion of caesarean sections in Latin-American mothers or the very lower proportion of breastfeeding in North-Asian immigrants. In addition, the analysis of deliveries at the Hospital de Poniente in El Ejido during the past decade indicates the need of eradicate obstacles for the access to prenatal care in all immigrant groups, something that can ameliorate their reproductive outcomes.