{"id":13212,"date":"2023-02-16T00:00:00","date_gmt":"2023-02-16T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/publications\/journal-articles\/severe-maternal-morbidity-and-mortality-among-immigrant-and-canadian-born-women-residing-within-low-income-neighborhoods-in-ontario-canada\/"},"modified":"2025-09-23T09:16:39","modified_gmt":"2025-09-23T13:16:39","slug":"severe-maternal-morbidity-and-mortality-among-immigrant-and-canadian-born-women-residing-within-low-income-neighborhoods-in-ontario-canada","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/severe-maternal-morbidity-and-mortality-among-immigrant-and-canadian-born-women-residing-within-low-income-neighborhoods-in-ontario-canada\/","title":{"rendered":"Severe maternal morbidity and mortality among immigrant and Canadian-born women residing within low-income neighborhoods in Ontario, Canada"},"content":{"rendered":"

Importance<\/strong> \u2014 Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas.<\/p>\n

Objective<\/strong> \u2014 To compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada.<\/p>\n

Design, Setting, and Participants<\/strong> \u2014 This population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414 337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks\u2019 gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal healthcare insurance. Statistical analysis was performed from December 2021 to March 2022.<\/p>\n

Exposures<\/strong> \u2014 Nonrefugee immigrant status vs nonimmigrant status.<\/p>\n

Main Outcomes and Measures<\/strong> \u2014 The primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or \u22653 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity.<\/p>\n

Results<\/strong> \u2014 The cohort included 148 085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266 252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52 447 [35.4%]) and the East Asia and Pacific (35 280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148 085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266 252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of \u22121.5 per 1000 births (95% CI, \u22122.3 to \u22120.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19).<\/p>\n

Conclusions and Relevance<\/strong> \u2014 This study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.<\/p>\n","protected":false},"excerpt":{"rendered":"

Importance \u2014 Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas. Objective \u2014 To compare the risk of SMM-M between immigrant and nonimmigrant women residing […]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[19,26,18,21],"migration-helper-qa-sample-set":[],"class_list":["post-13212","journal_article","type-journal_article","status-publish","hentry","topic-marginalized-populations","topic-maternity-and-neonatal-care","topic-racialized-communities","topic-women-or-gender-based-research"],"acf":{"citation":"Jairam JA, Vigod SN, Siddiqi A, Guan J, Boblitz A, Wang X, O'Campo P, Ray JG. JAMA Netw Open<\/em>. 2023; 6(2):e2256203. Epub 2023 Feb 16.","source_url":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2801492","ices_scientist":[1116,1338,1307],"site":[6733],"research_program":[6740],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"A344D80A-7298-47ED-B8FF-A1E7D30EBD11","sitecore_item_name":"Severe-maternal-morbidity-and-mortality-among-immigrant-and-Canadian-born-women","sitecore_field_values":"{\r\n \"Title\": \"Severe maternal morbidity and mortality among immigrant and Canadian-born women residing within low-income neighborhoods in Ontario, Canada\",\r\n \"Short title\": \"Severe maternal morbidity and mortality\",\r\n \"Summary\": \"This study suggests that women residing in low-income urban areas, immigrant women have a slightly lower associated risk of severe maternal morbidity or mortality than their nonimmigrant counterparts.\",\r\n \"Citation\": \"

Jairam JA, Vigod SN, Siddiqi A, Guan J, Boblitz A, Wang X, O'Campo P, Ray JG. JAMA Netw Open<\/em>. 2023; 6(2):e2256203. Epub 2023 Feb 16. DOI: https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.56203<\/a><\/p>\",\r\n \"Abstract\": \"

Importance<\/strong> — Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas.<\/p>n

Objective<\/strong> — To compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada.<\/p>n

Design, Setting, and Participants<\/span> — This population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414 337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks’ gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal healthcare insurance. Statistical analysis was performed from December 2021 to March 2022.<\/p>n

Exposures<\/strong> — Nonrefugee immigrant status vs nonimmigrant status.<\/p>n

Main Outcomes and Measures<\/span> — The primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or ≥3 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity.<\/p>n

Results<\/strong> — The cohort included 148 085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266 252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52 447 [35.4%]) and the East Asia and Pacific (35 280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148 085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266 252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of −1.5 per 1000 births (95% CI, −2.3 to −0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19).<\/p>n

Conclusions and Relevance<\/span> — This study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.<\/p>n

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