The influence of socio-demographic factors on miscarriage incidence among Italian and immigrant women: a critical analysis from Italy

A Retrospective Observational Study Using Administrative Databases to Assess the Risk of Spontaneous Abortions Related to Environmental and Socioeconomic Conditions

Miscarriage is one of the most frequent adverse events that occurs during pregnancy. This retrospective study aimed to verify if the environmental and socioeconomic conditions related to geographical areas where women live, and the socio-demographic and clinical factors play a role in the risk of spontaneous abortion (SA). The analyses were conducted by hospital discharge records (HDRs) from public and private hospitals in Apulia from 1 January 2021 to 31 December 2021. Women with an age over 40 years old had a major risk of SA compared with women under 18 years (OR 2.30, IC95%1.16-4.54). A reduction in the risk of SA was found for women with an endocrinological or metabolic disease (OR 0.28, 95% CI 0.19-0.41), while genetic disease greatly increases the risk (OR 9.63, IC95% 1.98-46.86). The greatest risk of spontaneous abortion was found in the province of Taranto compared to the province of Foggia (OR 2.01, 95% CI 1.52-2.64). The provinces with a higher risk of SA in the multiple comparisons were Taranto, Brindisi, and BAT. Municipalities with socioeconomic disadvantages classified as very low, low, and medium had a higher risk of SA compared to the municipalities with a high disadvantage. In conclusion, our study indicates the possible association between SA rate and environmental conditions. Additionally, the socioeconomic, clinical, and demographic factors were related to the risk of SAs.

The Pregnancy Outcomes Among Newly Arrived Asylum-Seekers in Italy: Implications of Public Health

Background

Migration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women.

Methods

Data about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors.

Results

Out of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion.

Conclusion

This study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women’s reproductive health.

Protective and risk factors for women's mental health after a spontaneous abortion

Objective:

to examine personal and contextual protective and risk factors associated with women’s mental health after a spontaneous abortion.

Method:

a cross-sectional study was carried out where 231 women who had experienced spontaneous abortions in the past 4 years answered a self-reporting online questionnaire to assess their mental health (symptoms of depression, anxiety, perinatal grief) and to collect personal as well as contextual characteristics.

Results:

women who had experienced spontaneous abortions within the past 6 months had higher scores for depressive symptoms than those who had experienced spontaneous abortions between 7 and 12 months ago, while anxiety level and perinatal grief did not vary according to the time since the loss. Moreover, low socioeconomic status, immigrant status, and childlessness were associated with worse mental health after a spontaneous abortion. In contrast, the quality of the conjugal relationship and the level of satisfaction with health care were positively associated with women’s mental health.

Conclusion:

women in vulnerable situations, such as immigrants, women with a low socioeconomic status, or childless women are particularly vulnerable to mental health problems after a spontaneous abortion. However, beyond those personal and contextual factors, the quality of the conjugal relationship and the level of satisfaction with health care could be important protective factors.

Factors associated with spontaneous abortion: a cross-sectional study of Chinese populations

Background

Spontaneous abortion (SA) is one of the prevalent negative reproductive outcomes among women around the world, which is a great challenge faced by maternal health promotion. The present study is aimed to explore the association between SA and socioeconomic status (SES) and provides reference for policy makers to improve strategies on maternal health promotion.

Methods

A cross-sectional analysis was conducted with baseline data from a large-scale population-based cohort study of 0.5 million people from 10 geographically diverse areas of China recruited from 2004 to 2008. The study collected data from 84,531 women aged 35–45 years old in the baseline survey of China Kadoorie Biobank. Participants were interviewed using a standardized questionnaire, and information on demographic-socioeconomic as well as reproductive health status was collected. Odds ratios (OR) with 95% CI, estimated by a multistep logistic regression, were used to approximate the associations between SA occurrence and characteristics of SES. A stratification analysis was also applied to find out how SES influenced women’s reproductive health outcomes differently between rural and urban areas. The model was adjusted for age at study date, tea consumption, alcohol consumption, cigarette smoking, and number of induced abortion.

Results

The risk of SA in rural was 1.68 times greater than in urban (AOR = 1.68, 95%CI: 1.54–1.84). Women with high income had a decreased risk of SA when compared with that of women with low income (AOR = 0.90, 95%CI: 0.84–0.97). Compared with women in low educational attainment, women in higher educational attainment had a lower prevalence of SA (AOR = 0.90, 95%CI: 0.82–0.98). The risk of SA only reduced in factory worker (AOR = 0.59, 95%CI: 0.53–0.66) and professional worker (AOR = 0.75, 95%CI: 0.66–0.84) compared with agriculture and related workers. After stratifying by rural/urban, the association between income and SA in urban (AOR = 0.88, 95%CI: 0.78–0.99) was stronger than that in rural (AOR = 0.92, 95%CI: 0.84–1.00). Association between education and SA was found in urban (AOR = 0.66, 95%CI: 0.55–0.78) but not in rural (AOR = 1.05, 95%CI: 0.34–1.17), and there was no difference on how occupation impacted SA among women between the two subgroups.

Conclusions

Generally women with lower SES status had a higher risk of SA. Lower income and educational attainment were inversely associated with the risk of SA. Women with agricultural and related work had a significantly higher prevalence of SA. Interventions could be targeted more on women with low SES to increase both health profits as well as economic gains for health programs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12978-017-0297-2) contains supplementary material, which is available to authorized users.

Hospital admissions among immigrants from low-income and foreign citizens from high-income countries in Spain in 2000-2012

Over the last decade, the number of foreign nationals in Spain has increased. Our aim was to report the trends in hospital admissions, differentiating between foreign nationals from high-income countries (HICs) and from low- and middle-income countries (LMICs) in a public hospital. A retrospective analysis of hospital admissions in patients aged ⩾15 years between 2000 and 2012 was performed by means of hospital information systems at a public hospital in the city of Alicante, Spain. During the period of the study, 387,862 patients were admitted: 32,020 (8.3%) were foreign, 22,446 (5.8%) were from LMICs, and 9574 (2.5%) were from HICs. The number of foreign nationals, foreign nationals from LMICs, and foreign nationals from HICs admitted increased from 1019, 530, and 489 in 2000 to 2925, 2097, and 828, respectively in 2012. A total of 27.5% of patients were admitted for pregnancy, childbirth, and puerperium, especially foreign nationals from LMICs (34.3%), and 14.1% of foreign nationals were admitted for cardiovascular diseases (14.1%), which were more common in those from HICs (26.3%). The number of admissions among foreign nationals from LMICs increased significantly in all the diagnoses, but in pregnancy, childbirth, and puerperium, the increase was higher. In conclusion, nearly one out of 10 adult patients admitted to our hospital was foreign, mainly from LMICs, and the main reason for admission was diagnoses related to pregnancy, childbirth, and puerperium.