Perinatal outcomes among immigrant mothers over two periods in a region of central Italy

<p>Abstract</p> <p>Background</p> <p>The number of immigrants has increased in Italy in the last twenty years (7.2% of the Italian population), as have infants of foreign-born parents, but scanty evidence on perinatal outcomes is available. The aim of this study was to investigate whether infants of foreign-born mothers living in Italy have different odds of adverse perinatal outcomes compared to those of native-born mothers, and if such measures changed over two periods.</p> <p>Methods</p> <p>The source of this area-based study was the regional hospital discharge database that records perinatal information on all births in the Lazio region. We analysed 296,739 singleton births born between 1996-1998 and 2006-2008. The exposure variable was the mother's region of birth. We considered five outcomes of perinatal health. We estimated crude and adjusted odds ratios and 95% confidence intervals (CIs) to evaluate the association between mother's region of birth and perinatal outcomes.</p> <p>Results</p> <p>Perinatal outcomes were worse among infants of immigrant compared to Italian mothers, especially for sub-Saharan and west Africans, with the following crude ORs (in 1996-1998 and 2006-2008 respectively): 1.80 (95%CI:1.44-2.28) and 1.95 (95%CI:1.72-2.21) for very preterm births, and 1.32 (95%CI:1.16-1.50) and 1.32 (95%CI:1.25-1.39) for preterm births; 1.18 (95%CI:0.99-1.40) and 1.17 (95%CI:1.03-1.34) for a low Apgar score; 1.22 (95%CI:1.15-1.31) and 1.24 (95%CI:1.17-1.32) for the presence of respiratory diseases; 1.47 (95%CI:1.30-1.66) and 1.45 (95%CI:1.34-1.57) for the need for special or intensive neonatal care/in-hospital deaths; and 1.03 (95%CI:0.93-1.15) and 1.07 (95%CI:1.00-1.15) for congenital malformations. Overall, time did not affect the odds of outcomes differently between immigrant and Italian mothers and most outcomes improved over time among all infants. None of the risk factors considered confounded the associations.</p> <p>Conclusion</p> <p>Our findings suggest that migrant status is a risk factor for adverse perinatal health. Moreover, they suggest that perinatal outcomes improved over time in some immigrant women. This could be due to a general improvement in immigrants' health in the past decade, or it may indicate successful application of policies that increase accessibility to mother-child health services during the periconception and prenatal periods for legal and illegal immigrant women in Italy.</p

Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

Introduction: A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer. Methods: The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4. Results: This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction. Conclusion: These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer

Preterm delivery risk in migrants in Italy. An observational prospective study

BACKGROUND: Various studies have ascertained different birth outcomes between resident and migrant populations in western countries. Considering preterm delivery (<37 complete weeks of gestation) as a perinatal risk condition, we assessed its rate in migrant and native Italian women who delivered in the main public hospital in Brescia (Italy). METHODS: All migrant puerperas and a random sample of native puerperas hospitalized during the period February to May 2005 were included in the study after informed consent and filled in a self-administered multilanguage questionnaire enquiring about sociodemographic and obstetric data. Additional information including last menstrual period was obtained from personal obstetric records. RESULTS: As many as 471 puerperas entered the study: 366 Italian and 105 migrant women coming from eastern Europe (41.9%), Asia (20%), South America (10.5%), and Africa (27.6%). Of the migrant population, 67 of 105 (63.8%) were at their first delivery in Italy (median interval from arrival: 3.8 y). Gestational age at delivery was assessed for 456 of 471 women (103 migrants and 353 Italians). A total of 36 (7.9%) preterm deliveries were registered: 22 (6.2%) in Italian and 14 (13.6%) in migrant puerperas (p value = 0.015). The highest preterm delivery rate was observed in African women (20.7%), while women from eastern Europe had a similar rate to Italians. In univariate analysis, factors associated to preterm delivery were parity and length of permanence in Italy. We could not demonstrate any correlation with smoking or with a delayed access to antenatal care (first obstetric evaluation after 12 complete weeks of gestation). In multivariate analysis, African origin was the only independent risk factor for preterm delivery [odds ratio (OR) = 3.54; p = 0.018]. CONCLUSIONS: In our setting, preterm delivery occurred more frequently in migrant women, particularly of African origin, and it is not associated to delayed access to antenatal care

Antenatal screening for mother to child infections in immigrants and residents: the case of toxoplasmosis in northern Italy.

In Italy, serological screening is recommended to prevent congenital toxoplasmosis as part of the antenatal care protocol. Our study investigates (1) adherence to screening among Italian and migrant women and (2) specific T. gondii seroprevalence among hospitalized puerperas in Brescia and Udine, in northern Italy. All migrants (Group B) and a random Italian sample (Group A) filled in a questionnaire. Serological screening was rated as adequate when performed before conception or by the 12th week of gestation, and periodically repeated during pregnancy whenever negative. Nine hundred and twenty-two (922) puerperas were enrolled (Group A: 743; Group B: 179). Mean gestational age at first antenatal visit was 9.3 week, significantly more delayed in migrants (11.2w vs 8.9w; P < 0.0001). Toxoplasmosis was mentioned as a potential vertically transmitted infection by 380/922 (41.2%), but only by 13.4% of migrants (P < 0.0001). Anti-Toxoplasma IgG-Ab tested positive in 319/892 (35.8%), while the information was missing for 9 and 21 women resulted untested. Patients from northern Africa had an higher (AOR 3.63%; P = 0.002), while Asian patients a lower (AOR 0.33; P = 0.045) probability of being immune. A late screening was recorded in 115/848 (13.6%) women (Group A: 9.35%; Group B: 31.9%; P < 0.0001) and 82.1% of eligible migrants were not correctly monitored for toxoplasmosis during pregnancy. A late toxoplasma serological test in migrant women precludes the timely application of preventive measure and may represent an indicator of suboptimal antenatal care

Antenatal Screening for Mother to Child Infections in Immigrants and Residents: The Case of Toxoplasmosis in Northern Italy

In Italy, serological screening is recommended to prevent congenital toxoplasmosis as part of the antenatal care protocol. Our study investigates (1) adherence to screening among Italian and migrant women and (2) specific T. gondii seroprevalence among hospitalized puerperas in Brescia and Udine, in northern Italy. All migrants (Group B) and a random Italian sample (Group A) filled in a questionnaire. Serological screening was rated as adequate when performed before conception or by the 12th week of gestation, and periodically repeated during pregnancy whenever negative. Nine hundred and twenty-two (922) puerperas were enrolled (Group A: 743; Group B: 179). Mean gestational age at first antenatal visit was 9.3 week, significantly more delayed in migrants (11.2w vs 8.9w; P < 0.0001). Toxoplasmosis was mentioned as a potential vertically transmitted infection by 380/922 (41.2%), but only by 13.4% of migrants (P < 0.0001). Anti-Toxoplasma IgG-Ab tested positive in 319/892 (35.8%), while the information was missing for 9 and 21 women resulted untested. Patients from northern Africa had an higher (AOR 3.63%; P = 0.002), while Asian patients a lower (AOR 0.33; P = 0.045) probability of being immune. A late screening was recorded in 115/848 (13.6%) women (Group A: 9.35%; Group B: 31.9%; P < 0.0001) and 82.1% of eligible migrants were not correctly monitored for toxoplasmosis during pregnancy. A late toxoplasma serological test in migrant women precludes the timely application of preventive measure and may represent an indicator of suboptimal antenatal care