Journal of Immigrant and Minority Health

, Volume 13, Issue 3, pp 417–425 | Cite as

Maternal Morbidity and Perinatal Outcomes Among Foreign-Born Cambodian, Laotian, and Vietnamese Americans in Washington State, 1993–2006

  • Swee May Cripe
  • William O’Brien
  • Bizu Gelaye
  • Michelle A. Williams
Original Paper


This study examined differences in perinatal outcomes of Southeast Asian (SEA) women compared with non-Hispanic white women in Washington. Using linked birth certificate and hospitalization discharge records for the years 1993–2006, we compared singleton births of Cambodian (3,858), Laotian (2,223), and Vietnamese (12,949) women with a random sample of white women (35,581). Associations between maternal nativity and perinatal outcomes were assessed using multivariable logistic regression. There are clear nativity differences among SEAs for gestational diabetes mellitus, anemia, placenta previa and febrile illness. SEAs had increased risks for these disorders when compared with white women. Compared with infants delivered of white women, infants of SEAs had increased risks for moderate to heavy meconium, birth injury and low birth weight. Differences in nativity among SEAs (populations that are traditionally studied in aggregate) should be considered when designing and carrying out interventions to prevent adverse pregnancy morbidity and outcomes among immigrants.


Antepartum complications Perinatal outcomes Cambodian Laotian Vietnamese 


  1. 1.
    Qin C, Gould JB. The Asian birth outcome gap. Paediatr Perinat Epidemiol. 2006;20:279–89.PubMedCrossRefGoogle Scholar
  2. 2.
    Frisbie WP, Cho Y, Hummer RA. Immigration and the health of Asian and Pacific Islander adults in the United States. Am J Epidemiol. 2001;153:372–80.PubMedCrossRefGoogle Scholar
  3. 3.
    Terrazas A, Batalova J. The most up-to-date frequently requested statistics on immigrants in the United States. Found at: (2008). Accessed 4 Mar 2009.
  4. 4.
    Terrazas A, Batalova J. 2007 American Community Survey and Census Data on Foreign-born by state. Found at: (2007). Accessed 22 May 2009.
  5. 5.
    Grieco E. The foreign born from Vietnam in the United States. Found at (2004). Accessed 4 Mar 2009.
  6. 6.
    Census Bureau US: Census 2000 summary file 3. 2000.Google Scholar
  7. 7.
    Marsh RE. Socioeconomic status of Indochinese refugees in the United States—progress and problems. Soc Secur Bull. 1980;43:11–20.PubMedGoogle Scholar
  8. 8.
    Schaefer UM, Songster G, Xiang A, et al. Congenital malformations in offspring of women with hyperglycemia first detected during pregnancy. Am J Obstet Gynecol. 1997;177:1165–71.PubMedCrossRefGoogle Scholar
  9. 9.
    O’Hare WJ. A new look at poverty in America. Popul Bull. 1992;51:1–47.Google Scholar
  10. 10.
    Rao AK, Cheng YW, Caughey AB. Perinatal complications among different Asian-American subgroups. Am J Obstet Gynecol. 2006;194:e39–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Rao AK, Daniels K, El-Sayed YY, et al. Perinatal outcomes among Asian American and Pacific Islander women. Am J Obstet Gynecol. 2006;195:834–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Lin-Fu JS. Population characteristics and health care needs of Asian Pacific Americans. Public Health Rep. 1988;103:18–27.PubMedGoogle Scholar
  13. 13.
    Singh GK, Yu SM. Pregnancy outcomes among Asian Americans. Asian Am Pac Isl J Health. 1993;1:63–78.PubMedGoogle Scholar
  14. 14.
    Barnes JS, Bennett CE. The Asian population: 2000. Census 2000 Brief, C2KBR/01-16; 2002. 12 pp.Google Scholar
  15. 15.
    Singh GK, Yu SM. Adverse pregnancy outcomes: differences between US- and foreign-born women in major US racial and ethnic groups. Am J Public Health. 1996;86:837–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Lydon-Rochelle MT, Holt VL, Cardenas V, et al. The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol. 2005;193:125–34.PubMedCrossRefGoogle Scholar
  17. 17.
    Lydon-Rochelle MT, Holt VL, Nelson JC, et al. Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington state linked birth records. Paediatr Perinat Epidemiol. 2005;19:460–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Johnson EB, Reed SD, Hitti J, et al. Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state. Am J Obstet Gynecol. 2005;193:475–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Savitz DA, Janevic TM, Engel SM, et al. Ethnicity and gestational diabetes in New York City, 1995–2003. BJOG. 2008;115:969–78.PubMedCrossRefGoogle Scholar
  20. 20.
    Rudra CB, Sorensen TK, Leisenring WM, et al. Weight characteristics and height in relation to risk of gestational diabetes mellitus. Am J Epidemiol. 2007;165:302–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Gann P, Nghiem L, Warner S. Pregnancy characteristics and outcomes of Cambodian refugees. Am J Public Health. 1989;79:1251–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Erickson RV, Hoang GN. Health problems among Indochinese refugees. Am J Public Health. 1980;70:1003–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Stein J, Berg C, Jones JA, et al. A screening protocol for a prenatal population at risk for inherited hemoglobin disorders: results of its application to a group of Southeast Asians and Blacks. Am J Obstet Gynecol. 1984;150:333–41.PubMedGoogle Scholar
  24. 24.
    Taylor VM, Peacock S, Kramer MD, et al. Increased risk of placenta previa among women of Asian origin. Obstet Gynecol. 1995;86:805–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Yang Q, Wu Wen S, Caughey S, et al. Placenta previa: its relationship with race and the country of origin among Asian women. Acta Obstet Gynecol Scand. 2008;87:612–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Maayan-Metzger A, Mazkereth R, Shani A, et al. Risk factors for maternal intrapartum fever and short-term neonatal outcome. Fetal Pediatr Pathol. 2006;25:169–77.PubMedCrossRefGoogle Scholar
  27. 27.
    Qing L, Keith LG, Kirby RS. Perinatal outcomes among foreign-born and US-born Chinese Americans, 1995–2000. J Immigr Minor Health. 2009; doi 10.1007/s10903-008-9191-x.
  28. 28.
    Fuentes-Afflick E, Hessol NA. Impact of Asian ethnicity and national origin on infant birth weight. Am J Epidemiol. 1997;145:148–55.PubMedGoogle Scholar
  29. 29.
    Baker LC, Afendulis CC, Chandra A, et al. Differences in neonatal mortality among whites and Asian American subgroups: evidence from California. Arch Pediatr Adolesc Med. 2007;161:69–76.PubMedCrossRefGoogle Scholar
  30. 30.
    Fuentes-Afflick E, Lurie P. Low birth weight and Latino ethnicity. Examining the epidemiologic paradox. Arch Pediatr Adolesc Med. 1997;151:665–74.PubMedGoogle Scholar
  31. 31.
    de la Rosa IA. Perinatal outcomes among Mexican Americans: a review of an epidemiological paradox. Ethn Dis. 2002;12:480–7.Google Scholar
  32. 32.
    Buekens P, Notzon F, Kotelchuck M, et al. Why do Mexican Americans give birth to few low-birth-weight infants? Am J Epidemiol. 2000;152:347–51.PubMedCrossRefGoogle Scholar
  33. 33.
    Patel A, Patel D, Keith L, et al. Epidemiologic paradox in multiple births among Asians in Illinois. Correlation between risk factors and outcomes. J Reprod Med. 1997;42:735–9.PubMedGoogle Scholar
  34. 34.
    Shiono PH, Klebanoff MA, Graubard BI, et al. Birth weight among women of different ethnic groups. JAMA. 1986;255:48–52.PubMedCrossRefGoogle Scholar
  35. 35.
    Shiono PH, Klebanoff MA. Ethnic differences in preterm and very preterm delivery. Am J Public Health. 1986;76:1317–21.PubMedCrossRefGoogle Scholar
  36. 36.
    Peckham CH, Christianson RE. The relationship between prepregnancy weight and certain obstetric factors. Am J Obstet Gynecol. 1971;111:1–7.PubMedGoogle Scholar
  37. 37.
    Davis JM, Goldenring J, McChesney M, et al. Pregnancy outcomes of Indochinese refugees, Santa Clara County, California. Am J Public Health. 1982;72:742–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Jasso G, Rosenzweig M. The new chosen people: immigrants in the United States. New York: Russell Sage Foundation; 1990.Google Scholar
  39. 39.
    Hopkins DD, Clarke NG. Indochinese refugee fertility rates and pregnancy risk factors, Oregon. Am J Public Health. 1983;73:1307–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Swee May Cripe
    • 1
  • William O’Brien
    • 1
  • Bizu Gelaye
    • 1
  • Michelle A. Williams
    • 1
  1. 1.Department of EpidemiologyUniversity of WashingtonSeattleUSA

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