The Role of Ethnicity and Migration in Perinatal Inequalities: A Retrospective Cohort Study.

Abstract

To examine ethnic disparities in perinatal outcomes and the role of migration factors. Retrospective cohort. Two maternity services in South London, UK. Women birthing singleton infants between 24 and 43 weeks' gestation (2018-2023). Linked electronic health records were analysed using generalised linear mixed models (GLMMs) with Poisson distribution to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI) by ethnicity, migration, interpreter need, and country-of-origin income, adjusting for socioeconomic deprivation and medical risk. Emergency caesarean, haemorrhage, preterm birth, low birthweight, low Apgar score, stillbirth or neonatal death. Among 44 634 births, compared with White women, emergency caesarean risk was higher for Asian (aRR 1.22, 95% CI 1.14-1.30, p < 0.001) and Black women (1.16, 1.10-1.23, p < 0.001). Haemorrhage was higher for Asian women (1.12, 1.02-1.23, p = 0.021), those needing interpretation (1.16, 1.06-1.27, p < 0.001), and lower for Mixed ethnicity women (0.86, 0.74-0.99, p = 0.038). Infants of Black women had elevated risks of preterm birth (1.23, 1.13-1.34, p < 0.001), low birthweight (1.74, 1.60-1.89, p < 0.001), low Apgar (2.06, 1.71-2.48, p < 0.001), and stillbirth/neonatal death (1.57, 1.21-2.05, p < 0.001). Asian infants had increased risks of preterm birth (1.19, 1.07-1.33, p = 0.002) and low birthweight (1.69, 1.52-1.87, p < 0.001). Foreign-born women had lower risks of low birthweight (0.71, 0.62-0.81, p < 0.001) but higher risks of low Apgar (1.24, 1.06-1.46, p = 0.009) and stillbirth/neonatal death (1.33, 1.07-1.65, p = 0.011). Risks were highest for ethnic minority, foreign-born women, though effect sizes were modest. Ethnic minority and foreign-born women, particularly from LMICs or needing interpreters, face elevated risks with modest clinical impact.