Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries.
OBJECTIVE
To assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries.


DESIGN
Cross-country comparative study of linked population-based databases.


SETTING
Provincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden.


POPULATION
All immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995-2010).


METHODS
Data was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI).


MAIN OUTCOME MEASURES
Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries).


RESULTS
There were 9,028,802 deliveries (3,031,399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest.


CONCLUSION
Immigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.
['Urquia|M L|ML|', 'Glazier|R H|RH|', 'Gagnon|A J|AJ|', 'Mortensen|L H|LH|', 'Nybo Andersen|A-M|AM|', 'Janevic|T|T|', 'Guendelman|S|S|', 'Thornton|D|D|', 'Bolumar|F|F|', 'Río Sánchez|I|I|', 'Small|R|R|', 'Davey|M-A|MA|', 'Hjern|A|A|', '|||']
D000328:Adult D017954:Africa South of the Sahara D001315:Australia D002170:Canada D017691:Caribbean Region D016208:Databases, Factual D019049:Developed Countries D004461:Eclampsia D054242:Emigrants and Immigrants D005060:Europe D005202:Far East D005260:Female D054624:Health Status Disparities D006801:Humans D007843:Latin America D007902:Length of Stay D016015:Logistic Models D008875:Middle Aged D011225:Pre-Eclampsia D011247:Pregnancy D014481:United States
pre-eclampsia Eclampsia immigration industrialised countries health disparities pregnancy complications