Association between Migrant Women’s Legal Status and Prenatal Care Utilization in the PreCARE Cohort
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Inadequate Prenatal Care * | |||
---|---|---|---|
n | % | p ** | |
Migrants with French or European nationality not born in SSA (n = 1174) | 360 | 30.7 | 0.2 |
Migrants with French or European nationality born in SSA (n = 381) | 131 | 34.4 | |
Other legal migrants not born in SSA (n = 1929) | 740 | 38.4 | 0.002 |
Legal migrants born in SSA (n = 877) | 391 | 44.6 | |
Undocumented migrants not born in SSA (n = 407) | 198 | 48.6 | 0.04 |
Undocumented migrants born in SSA (n = 308) | 174 | 56.5 |
Inadequate Prenatal Care * | ||
---|---|---|
Complete cases (n = 8869) | Multiple imputations (n = 9599) | |
aOR [95% CI] 1 | aOR [95% CI] 1 | |
Nonmigrants (n = 4523) | 1 | 1 |
Migrants with French or European nationality (n = 1555) | 1.17 [1.02–1.33] | 1.17 [1.03–1.33] |
Other legal migrants (n = 2806) | 1.61 [1.44–1.80] | 1.60 [1.43–1.78] |
Undocumented migrants (n = 715) | 2.58 [2.16–3.09] | 2.58 [2.16–3.07] |
Inadequate Prenatal Care * | ||
---|---|---|
OR [95% CI] | aOR [95% CI] 1 | |
Nonmigrants (n = 4511) | 1 | 1 |
Migrants with French or European nationality (n = 1508) | 1.24 [1.09–1.42] | 1.09 [0.95–1.26] |
Legal migrants (n = 2527) | 1.79 [1.61–1.99] | 1.49 [1.32–1.67] |
Undocumented migrants (n = 569) | 2.65 [2.21–3.18] | 2.19 [1.80–2.67] |
Study Population (n = 9599) | Women Excluded (n = 619) | ||||
---|---|---|---|---|---|
n | % | n | % | p | |
Legal status | 0.3 | ||||
Nonmigrants | 4523 | 47.1 | 277 | 44.7 | |
Migrants with French or European nationality | 1555 | 16.2 | 93 | 15.0 | |
Other legal migrants | 2806 | 29.2 | 154 | 24.9 | |
Undocumented migrants | 715 | 7.4 | 54 | 8.7 | |
Missing | 0 | 0.0 | 41 | 6.6 | |
Maternal birthplace | <0.001 | ||||
Metropolitan France | 4363 | 45.5 | 262 | 42.4 | |
Oversea French territories | 166 | 1.7 | 15 | 2.4 | |
Europe (other) | 467 | 4.9 | 38 | 6.1 | |
North Africa | 2116 | 22.0 | 103 | 16.6 | |
Sub-Saharan Africa | 1566 | 16.3 | 115 | 18.6 | |
Asia–Middle East | 626 | 6.5 | 27 | 4.4 | |
Others | 295 | 3.1 | 59 | 9.5 | |
Missing | 0 | 0.0 | 0 | 0.0 | |
Maternal age (years) | <0.001 | ||||
<20 | 128 | 1.3 | 19 | 3.1 | |
[20,21,22,23,24,25] | 1303 | 13.6 | 99 | 16.0 | |
[25,26,27,28,29,30] | 2912 | 30.3 | 184 | 29.7 | |
[30,31,32,33,34,35,36,37,38,39,40] | 4793 | 49.9 | 271 | 43.8 | |
≥40 | 463 | 4.8 | 46 | 7.4 | |
Missing | 0 | 0.0 | 0 | 0.0 | |
Living alone | 1409 | 14.7 | 130 | 21.0 | <0.001 |
Missing | 27 | 0.3 | 41 | 6.6 | |
Deprivation index * | <0.001 | ||||
0 criterion | 6322 | 65.9 | 340 | 54.9 | |
1 criterion | 1681 | 17.5 | 97 | 15.7 | |
2 criteria | 839 | 8.7 | 66 | 10.7 | |
3 or 4 criteria | 660 | 6.9 | 67 | 10.8 | |
Missing | 97 | 1.0 | 49 | 7.9 | |
Schooling level | 0.2 | ||||
≤Primary school | 667 | 6.9 | 37 | 6.0 | |
Middle school | 1746 | 18.2 | 98 | 15.8 | |
High school | 2299 | 24.0 | 124 | 20.0 | |
University | 4792 | 49.9 | 318 | 51.4 | |
Missing | 95 | 1.0 | 42 | 6.8 | |
Social welfare coverage | 0.02 | ||||
Standard health insurance | 1368 | 14.3 | 86 | 13.9 | |
Complementary health insurance | 6001 | 62.5 | 338 | 54.6 | |
Universal health coverage | 1191 | 12.4 | 69 | 11.1 | |
State medical assistance | 586 | 6.1 | 38 | 6.1 | |
No healthcare insurance | 367 | 3.8 | 38 | 6.1 | |
Missing | 86 | 0.9 | 50 | 8.1 |
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Nonmigrants (n = 4523) | Migrants with French or European Nationality (n = 1555) | Other Legal Migrants (n = 2806) | Undocumented Migrants (n = 715) | p **** | |||||
---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | ||
Age (years) (n = 9599) | <0.001 | ||||||||
<20 | 76 | 1.7 | 13 | 0.8 | 26 | 0.9 | 13 | 1.8 | |
[20,21,22,23,24,25] | 606 | 13.4 | 188 | 12.1 | 375 | 13.4 | 134 | 18.7 | |
[25,26,27,28,29,30] | 1428 | 31.6 | 362 | 23.3 | 871 | 31.0 | 251 | 35.1 | |
[30,31,32,33,34,35,36,37,38,39,40] | 2255 | 49.9 | 864 | 55.6 | 1379 | 49.1 | 295 | 41.3 | |
≥40 | 158 | 3.5 | 128 | 8.2 | 155 | 5.5 | 22 | 3.1 | |
Social isolation (n = 9596) | 77 | 1.7 | 55 | 3.5 | 172 | 6.1 | 123 | 17.2 | <0.001 |
Poor or insecure housing conditions (n = 9596) | 412 | 9.1 | 175 | 11.3 | 510 | 18.2 | 406 | 56.8 | <0.001 |
No standard healthcare insurance (n = 9585) | 396 | 8.8 | 276 | 17.7 | 833 | 29.7 | 639 | 89.4 | <0.001 |
No work-related household income (n = 9593) | 435 | 9.6 | 194 | 12.5 | 520 | 18.5 | 335 | 46.9 | <0.001 |
Deprivation index * (n = 9502) | <0.001 | ||||||||
0 criterion | 3661 | 80.9 | 1087 | 69.9 | 1574 | 56.1 | 0 | 0.0 | |
1 criterion | 515 | 11.4 | 293 | 18.8 | 667 | 23.8 | 206 | 28.8 | |
2 criteria | 240 | 5.3 | 117 | 7.5 | 337 | 12.0 | 145 | 20.3 | |
3 or 4 criteria | 103 | 2.3 | 55 | 3.5 | 216 | 7.7 | 286 | 40.0 | |
Schooling level (n = 9504) | <0.001 | ||||||||
≤Primary school | 32 | 0.7 | 88 | 5.7 | 391 | 13.9 | 156 | 21.8 | |
Middle school | 643 | 14.2 | 297 | 19.1 | 633 | 22.6 | 173 | 24.2 | |
High school | 892 | 19.7 | 419 | 26.9 | 793 | 28.3 | 195 | 27.3 | |
University | 2943 | 65.1 | 736 | 47.3 | 943 | 33.6 | 170 | 23.8 | |
Social welfare coverage at inclusion (n = 9513) | <0.001 | ||||||||
Standard health insurance (SHI) | 429 | 9.5 | 264 | 17.0 | 675 | 24.1 | 0 | 0.0 | |
SHI + Complementary health insurance | 3695 | 81.7 | 1013 | 65.1 | 1293 | 46.1 | 0 | 0.0 | |
Universal health coverage (CMU) | 366 | 8.1 | 218 | 14.0 | 607 | 21.6 | 0 | 0.0 | |
State medical assistance (AME) | 1 | 0.0 | 22 | 1.4 | 90 | 3.2 | 473 | 66.2 | |
No healthcare insurance | 29 | 0.6 | 36 | 2.3 | 136 | 4.8 | 166 | 23.2 | |
Maternal birthplace (n = 9583) | <0.001 | ||||||||
Metropolitan France | 4357 | 96.3 | 0 | 0.0 | 0 | 0.0 | 6 | 0.8 | |
Overseas French territory | 166 | 3.7 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | |
Europe (other) | 0 | 0.0 | 339 | 21.8 | 77 | 2.7 | 51 | 7.1 | |
North Africa | 0 | 0.0 | 611 | 39.3 | 1314 | 46.8 | 191 | 26.7 | |
Sub-Saharan Africa | 0 | 0.0 | 381 | 24.5 | 877 | 31.3 | 308 | 43.1 | |
Asia–Middle East | 0 | 0.0 | 128 | 8.8 | 379 | 13.6 | 109 | 15.2 | |
Other | 0 | 0.0 | 86 | 5.5 | 159 | 5.7 | 50 | 7.0 | |
Length of residency (median in months) ** (n = 8687) IQR 25/75 | 141.4 82.7 | 250.6 | 71.9 26.0 | 118.8 | 31.6 9.4 | 73.4 | <0.001 | ||
Language barrier (n = 9322) | 41 | 0.9 | 150 | 9.6 | 575 | 20.5 | 241 | 33.7 | <0.001 |
Smoked before pregnancy (n = 9507) | 1237 | 27.3 | 206 | 13.2 | 138 | 4.9 | 45 | 6.3 | <0.001 |
Smoked during pregnancy (n = 9455) | 644 | 14.2 | 113 | 7.3 | 66 | 2.4 | 21 | 2.9 | <0.001 |
Alcohol during pregnancy (n = 9471) | 372 | 8.2 | 96 | 6.2 | 134 | 4.8 | 61 | 8.5 | <0.001 |
Drugs during pregnancy (n = 9594) | 39 | 0.9 | 5 | 0.3 | 6 | 0.2 | 1 | 0.1 | <0.001 |
Prepregnancy BMI (kg/m2) (n = 9599) | <0.001 | ||||||||
<18.5 | 303 | 6.7 | 76 | 4.9 | 122 | 4.3 | 46 | 6.4 | |
18.5–24.9 | 2844 | 62.9 | 864 | 55.6 | 1361 | 48.5 | 318 | 44.5 | |
25–29.9 | 767 | 17.0 | 366 | 23.5 | 733 | 26.1 | 167 | 23.4 | |
≥30 | 505 | 11.2 | 187 | 12.0 | 376 | 13.4 | 80 | 11.2 | |
Nulliparous (n = 9587) High risk at the beginning of pregnancy *** (n = 9550) | 2302 925 | 50.9 20.5 | 520 297 | 33.4 19.1 | 963 521 | 34.3 18.6 | 332 124 | 46.4 17.3 | <0.001 0.1 |
Nonmigrants (n = 4523) | Migrants with French or European Nationality (n = 1555) | Other Legal Migrants (n = 2806) | Undocumented Migrants (n = 715) | p *** | |||||
---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | ||
Initiation of care ≥14 GW (n = 9586) | 641 | 14.2 | 238 | 15.3 | 524 | 18.7 | 214 | 29.9 | <0.001 |
Percentage of recommended prenatal visits <50% * (n = 9566) | 118 | 2.6 | 35 | 2.3 | 85 | 3.0 | 43 | 6.0 | <0.001 |
First trimester ultrasound not performed between 11 and 14 GW (n = 9256) | 781 | 17.3 | 349 | 22.4 | 857 | 30.5 | 304 | 42.5 | <0.001 |
Second trimester ultrasound not performed between 21 and 24 GW (n = 9391) | 689 | 15.2 | 312 | 20.1 | 606 | 21.6 | 204 | 28.5 | <0.001 |
Third trimester ultrasound not performed between 31 and 34 GW (n = 9433) | 753 | 16.6 | 278 | 17.9 | 584 | 20.8 | 160 | 22.4 | <0.001 |
Inadequate prenatal care according to mAPNCU index ** | 1196 | 26.4 | 491 | 31.6 | 1131 | 40.3 | 372 | 52.0 | <0.001 |
Missing data for an item of the index | 307 | 6.8 | 121 | 7.8 | 171 | 6.1 | 43 | 6.0 | |
Indirect indicators of prenatal care | |||||||||
Pre-anesthesia evaluation ≥37 GW (n = 9061) | 438 | 9.7 | 160 | 10.3 | 347 | 12.4 | 91 | 12.7 | 0.001 |
No determination of Rhesus group before entering the delivery room (n = 9531) | 23 | 0.5 | 7 | 0.5 | 15 | 0.5 | 4 | 0.6 | 0.9 |
No hepatitis B serology determination before entering the delivery room (n = 9550) | 33 | 0.7 | 6 | 0.4 | 15 | 0.5 | 3 | 0.4 | 0.4 |
No predelivery identification of estimated fetal weight >95th percentile (among 479 women with birth weight >95th percentile, n = 9506) | 71 | 39.0 | 32 | 32.7 | 65 | 38.0 | 13 | 46.4 | 0.6 |
No predelivery identification of estimated fetal weight <3rd percentile (among 343 women with birth weight <3rd percentile, n = 9439) | 58 | 34.9 | 25 | 44.6 | 41 | 50.0 | 8 | 20.5 | 0.007 |
No predelivery identification of placenta previa (among 124 women with placenta previa, n = 9422) | 5 | 9.1 | 3 | 15.0 | 3 | 8.6 | 0 | 0 | 0.5 |
No predelivery identification of multiple pregnancy (among 141 women with multiple pregnancy, n = 9547) | 13 | 19.4 | 0 | 0 | 6 | 14.3 | 1 | 12.5 | 0.1 |
No predelivery identification of uterine scar (among 1311 women with a uterine scar, n = 9520) | 27 | 5.7 | 14 | 5.6 | 25 | 5.3 | 8 | 7.2 | 0.9 |
No predelivery identification of breech presentation (among 392 women with breech delivery, n = 9511) | 22 | 10.9 | 5 | 9.4 | 11 | 10.4 | 2 | 6.5 | 0.9 |
Inadequate Prenatal Care * | ||
---|---|---|
OR [95% CI] | aOR [95% CI] 1 | |
Nonmigrants (n = 4523) | 1 | 1 |
Migrants with French or European nationality (n = 1555) | 1.31 [1.16–1.49] | 1.17 [1.03–1.33] |
Legal migrants (n = 2806) | 1.90 [1.71–2.10] | 1.60 [1.43–1.78] |
Undocumented migrants (n = 715) | 3.13 [2.65–3.70] | 2.58 [2.16–3.07] |
Inadequate Prenatal Care * | ||
---|---|---|
OR [95% CI] | aOR [95% CI] 1 | |
Nonmigrants (n = 4523) | 1 | 1 |
Migrants with French or European nationality not born in SSA (n = 1174) | 1.25 [1.09–1.44] | 1.15 [0.99–1.34] |
Migrants with French or European nationality born in SSA (n = 381) | 1.52 [1.21–1.91] | 1.22 [0.97–1.55] |
Other legal migrants not born in SSA (n = 1929) | 1.73 [1.54–1.94] | 1.54 [1.37–1.75] |
Other legal migrants born in SSA (n = 877) | 2.35 [2.02– 2.73] | 1.80 [1.52–2.12] |
Undocumented migrants not born in SSA (n = 407) | 2.75 [2.22–3.40] | 2.37 [1.89–2.97] |
Undocumented migrants born in SSA (n = 308) | 3.72 [2.92–4.75] | 2.95 [2.28–3.82] |
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Eslier, M.; Deneux-Tharaux, C.; Sauvegrain, P.; Schmitz, T.; Luton, D.; Mandelbrot, L.; Estellat, C.; Azria, E. Association between Migrant Women’s Legal Status and Prenatal Care Utilization in the PreCARE Cohort. Int. J. Environ. Res. Public Health 2020, 17, 7174. https://doi.org/10.3390/ijerph17197174
Eslier M, Deneux-Tharaux C, Sauvegrain P, Schmitz T, Luton D, Mandelbrot L, Estellat C, Azria E. Association between Migrant Women’s Legal Status and Prenatal Care Utilization in the PreCARE Cohort. International Journal of Environmental Research and Public Health. 2020; 17(19):7174. https://doi.org/10.3390/ijerph17197174
Chicago/Turabian StyleEslier, Maxime, Catherine Deneux-Tharaux, Priscille Sauvegrain, Thomas Schmitz, Dominique Luton, Laurent Mandelbrot, Candice Estellat, and Elie Azria. 2020. "Association between Migrant Women’s Legal Status and Prenatal Care Utilization in the PreCARE Cohort" International Journal of Environmental Research and Public Health 17, no. 19: 7174. https://doi.org/10.3390/ijerph17197174