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Neonatal Outcomes for Immigrant vs. Native-Born Mothers in Taiwan: An Epidemiological Paradox

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Abstract

In Taiwan, immigrant women by marriage face social discrimination due to widespread impressions that they give birth to low birth weight, high-risk, high cost babies due to their lower socioeconomic status, shorter stature, and lower pre-pregnant weight than native-born Taiwanese women. This study compared crude and adjusted birth outcomes of immigrant mothers (Chinese and Vietnamese) relative to native-born Taiwanese, and tested for the phenomenon of an epidemiological paradox of favorable neonatal outcomes among immigrants. Data from patient charts of all singleton live births during 2002–2007, weighing ≥500 and <4,000 g, and ≥20 weeks gestational age at a regional hospital in Kaohsiung, Taiwan, were used. Multiple regression analysis was used to test the hypothesis controlling for maternal characteristics (demographics, national origin, obstetric and prenatal factors) and neonatal characteristics (birth weight, gestational age). Of 3,267 births satisfying the inclusion criteria, 19.0% were to Chinese and Vietnamese mothers. Crude birth weight was lowest for Taiwanese mothers, who also had the highest rate of preterm delivery (<37 weeks). The adjusted birth weight for Chinese and Vietnamese mothers was 87.7 and 74.7 g higher, respectively than native-born Taiwanese (both P < 0.001). Chinese and Vietnamese mothers also had lower odds of preterm birth (ORs 0.46 and 0.47, respectively). Findings support paradoxically better neonatal outcomes among Chinese and Vietnamese immigrant mothers in Taiwan. Findings can be used to initiate public education to reverse the widespread negative perceptions and attitudes towards immigrant spouses in Taiwan.

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References

  1. Wang, L. (2009). Change of population structure from total fertility rate perspective. Council for Economic Planning and Development. Accessed June 15, 2009. Available at http://www.cepd.gov.tw/m1.aspx?sNo=0011563&ex=%20&ic=.

  2. National statistics. (2009). Accessed March 8, 2009. Available at http://ebas1.ebas.gov.tw/pxweb/Dialog/Searchpx2.asp?SQ=Q&lang=9.

  3. Ministry of Interior. (2008). Number of marriage and divorce registration by nationality in Taiwan-Fuchien Area. Accessed June 15, 2008. Available at http://www.moi.gov.tw/stat/index.asp.

  4. Ministry of Interior. (2008). Foreign and mainland Chinese spouse Life Survey. Accessed January 20, 2008. Available at http://www.ris.gov.tw/ch4/0930617.html.

  5. Liao, C.-C., & Chan, W.-Y. (2005). Concerns over the life and health of alien brides from Southeastern Asia and Mainland China. Tzu Chi Nursing Journal, 4, 12–16.

    Google Scholar 

  6. Unites States Department of State, Bureau of Democracy, Human Rights and Labor Report on Taiwan dated March 11, 2008. Accessed April 2, 2010 at http://www.state.gov/g/drl/rls/hrrpt/2007/100517.htm.

  7. Bureau of Health Promotion. (2008). 2003 Statistics of birth reporting system. Accessed March 8, 2008. Available at http://www.bhp.doh.gov.tw/download/themeParkId=542/960301/960301.htm.

  8. Wang, H.-H., Chung, U.-L., Chou, P.-H., & Chiang, Y.-P. (2006). Physical and mental pressure—a survey on pregnant women in Taiwan who originally came from Southeast Asia. Journal of Health Management, 4, 89–101.

    Google Scholar 

  9. Sung, J., Taylor, B., & Blumenthal, D. (1994). Maternal factor, birthweight and racial differences in infant mortality: a Georgian population-based study. Journal of the National Medical Association, 86, 437–443.

    CAS  PubMed  Google Scholar 

  10. Shmueli, A., & Cullen, M. R. (1999). Birth weight, maternal age, and education: new observations from Connecticut and Virginia. Yale Journal of Biological Medicine, 72, 245–258.

    CAS  Google Scholar 

  11. Gould, J. B., Madan, A., Qin, C., & Chavez, G. (2003). Perinatal outcomes in two dissimilar immigrant populations in the United States: A dual epidemiologic paradox. Pediatrics, 111, e676–e682.

    Article  PubMed  Google Scholar 

  12. de la Rosa, I. A. (2002). Perinatal outcomes among Mexican Americans: A review of an epidemiological paradox. Ethnicity and Disease, 12, 480–487.

    PubMed  Google Scholar 

  13. Centers for Disease Control, Prevention. (2002). State-specific trends in U.S. live births to women born outside the 50 states, the District of Columbia—United States, 1990 and 2000. MMWR Morbidity and Mortality Weekly Report, 51, 1091–1095.

    Google Scholar 

  14. Crump, C., Lipsky, S., & Mueller, B. (1999). Adverse birth outcomes among Mexican–Americans: are US-born women at greater risk than Mexico-born women? Ethnicity & Health, 4, 29–34.

    Article  CAS  Google Scholar 

  15. English, P., Kharrazi, M., & Guendelman, S. (1997). Pregnancy outcomes and risk factors in Mexican Americans: the effect of language use and mother’s birthplace. Ethnicity and Disease, 7, 229–240.

    CAS  PubMed  Google Scholar 

  16. Hessol, N. A., & Fuentes-Afflick, E. (2000). The perinatal advantage of Mexican-origin Latina women. Annals of Epidemiology, 10, 516–523.

    Article  CAS  PubMed  Google Scholar 

  17. Madan, A., Holland, S., Humbert, J. E., & Benitz, W. E. (2002). Racial differences in birth weight of term infants in a northern California population. Journal of Perinatology, 22, 230–235.

    Article  PubMed  Google Scholar 

  18. Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., Kirmeyer, S., et al. (2009). Births: Final Data for 2006. National Vital Statistics Reports, 57.

  19. Kim, H., Chang, K., Yang, J., Yang, S., Lee, H., & Ryu, H. (2002). Clinical outcomes of pregnancy with one elevated glucose tolerance test value. International Journal of Obstetrics & Gynecology, 78, 132–138.

    Google Scholar 

  20. National Diabetes Data Group. (1979). Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes, 28, 1039–1057.

    Google Scholar 

  21. Cheng, Y. W., Block-Kurbisch, I., & Caughey, A. B. (2009). Carpenter-Coustan criteria compared with the national diabetes data group thresholds for gestational diabetes mellitus. Obstetrics and Gynecology, 114(2 Pt 1), 326–332.

    Article  PubMed  Google Scholar 

  22. Oken, E., Ning, Y., Rifas-Shiman, S. L., Rich-Edwards, J. W., Olsen, S. F., & Gillman, M. W. (2007). Diet during pregnancy and risk of preeclampsia or gestational hypertension. Annals of Epidemiology, 17, 663–668.

    Article  PubMed  Google Scholar 

  23. Moraes, C. L., Amorim, A. R., & Reichenheim, M. E. (2006). Gestational weight gain differentials in the presence of intimate partner violence. International Journal of Obstetrics & Gynecology, 95, 254–260.

    Article  CAS  Google Scholar 

  24. Kotelchuck, M. (1994). An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health, 84, 1414–1420.

    Article  CAS  PubMed  Google Scholar 

  25. Kotelchuck, M. (2009). Overview of adequacy of prenatal care utilization index. Accessed October 6, 2009. Available at http://www.mchlibrary.info/databases/HSNRCPDFs/Overview_APCUIndex.pdf.

  26. Acevedo-Garcia, D., Soobader, M. J., & Berkman, L. F. (2007). Low birthweight among US Hispanic/Latino subgroups: the effect of maternal foreign-born status and education. Social Science and Medicine, 65, 2503–2516.

    Article  PubMed  Google Scholar 

  27. Callister, L. C., & Birkhead, A. (2002). Acculturation and perinatal outcomes in Mexican immigrant childbearing women: An integrative review. Journal of Perinatal & Neonatal Nursing, 16, 22–38.

    Google Scholar 

  28. Guendelman, S., Buekens, P., Blondel, B., Kaminski, M., Notzon, F. C., & Masuy-Stroobant, G. (1999). Birth outcomes of immigrant women in the United States, France, and Belgium. Maternal and Child Health Journal, 3, 177–187.

    Article  CAS  PubMed  Google Scholar 

  29. Acevedo-Garcia, D., Soobader, M.-J., & Berkman, L. F. (2005). The differential effect of foreign-born status on low birth weight by race/ethnicity and education. Pediatrics, 115, e20–e30.

    PubMed  Google Scholar 

  30. Cho, Y., Song, S.-E., & Frisbie, W. P. (2005). Adverse birth outcomes among Korean Americans: The impactof nativity and social proximity to other Koreans. Population Research and Policy Review, 24, 263–282.

    Article  Google Scholar 

  31. Berkowitz, G. S., & Papiernik, E. (1993). Epidemiology of preterm birth. Epidemiologic Reviews, 15, 414–443.

    CAS  PubMed  Google Scholar 

  32. Miletic, T., & Stoini, E. (2005). Influence of maternal pregravid weight, height and body mass index on birth weight of male and female newborns. Collegium Antropologicum, 29, 263–266.

    PubMed  Google Scholar 

  33. Buekens, P., Notzon, F., Kotelchuck, M., & Wilcox, A. (2000). Why do Mexican Americans give birth to few low-birth-weight infants? American Journal of Epidemiology, 152, 347–351.

    Article  CAS  PubMed  Google Scholar 

  34. Fuentes-Afflick, E., Hessol, N. A., & Perez-Stable, E. J. (1999). Testing the epidemiologic paradox of low birth weight in Latinos. Archives of Pediatrics and Adolescent Medicine, 153, 147–153.

    CAS  PubMed  Google Scholar 

  35. Rosenberg, T. J., Raggio, T. P., & Chiasson, M. A. (2005). A further examination of the “epidemiologic paradox”: Birth outcomes among Latinas. Journal of National Medical Association, 97, 550–556.

    Google Scholar 

  36. Auger, N., Luo, Z. C., Platt, R. W., & Daniel, M. (2008). Do mother’s education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect. Journal of Epidemiology and Community Health, 62, 402–409.

    Article  CAS  PubMed  Google Scholar 

  37. Triantafyllidis, G., Christopoulou, C., & Damianaki, D. (2009). Gestational age, birthweight and feeding policy differences between Greek and immigrant women in a public nursey. International conference on health promoting hospital and health services, 2009, Crete, Greece, p. p153.

  38. Chan, A., Roder, D., & Macharper, T. (1988). Obstetric profiles of immigrant women from non-English speaking countries in South Australia, 1981–1983. Australian and New Zealand Journal of Obstetrics and Gynaecology, 28, 90–95.

    Article  CAS  PubMed  Google Scholar 

  39. Yu, D. M., Zhao, L. Y., Liu, A. D., Yu, W. T., Jia, F. M., & Zhang, J. G. (2007). et al. [Incidence of low birth weight of neonates and the influencing factors in China]. Zhonghua Yu Fang Yi Xue Za Zhi, 41(Suppl), 150–154.

    PubMed  Google Scholar 

  40. Dinh, P. H., To, T. H., Vuong, T. H., Hojer, B., & Persson, L. A. (1996). Maternal factors influencing the occurrence of low birthweight in northern Vietnam. Annals of Tropical Paediatrics, 16, 327–333.

    CAS  PubMed  Google Scholar 

  41. WHO. (2002). Meeting of Advisory Group on maternal nutrition and low birthweight, December 4–6, 2002, Geneva.

  42. Cho, Y., & Hummer, R. A. (2001). Disability status differentials across fifteen Asian and Pacific Islander groups and the effect of nativity and duration of residence in the US. Social Biology, 48, 171–195.

    CAS  PubMed  Google Scholar 

  43. Collins, J. W., Jr., & Shay, D. K. (1994). Prevalence of low birth weight among Hispanic infants with United States-born and foreign-born mothers: the effect of urban poverty. American Journal of Epidemiology, 139, 184–192.

    PubMed  Google Scholar 

  44. Lee, S. K., Sobal, J., & Frongillo, E. A., Jr. (2000). Acculturation and health in Korean Americans. Social Science and Medicine, 51, 159–173.

    Article  CAS  PubMed  Google Scholar 

  45. Fuentes-Afflick, E., & Hessol, N. A. (1997). Impact of Asian ethnicity and national origin on infant birth weight. American Journal of Epidemiology, 145, 148–155.

    CAS  PubMed  Google Scholar 

  46. Thamer, M., Richard, C., Casebeer, A. W., & Ray, N. F. (1997). Health insurance coverage among foreign-born US residents: the impact of race, ethnicity, and length of residence. American Journal of Public Health, 87, 96–102.

    Article  CAS  PubMed  Google Scholar 

  47. Soldo, B., Wong, R., & Palloni, A. (2002). Migrant health selection: Evidence from Mexico and the US. Population Association of America Annual Meeting, May 9–11, 2002, Atlanta, GA.

  48. Scribner, R. (1996). Paradox as paradigm–the health outcomes of Mexican Americans. American Journal of Public Health, 86, 303–305.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA

    Sudha Xirasagar & Janice C. Probst

  2. Department of Obstetrics and Gynecology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan ROC

    Jung-Chung Fu & Duey-Perng Lin

  3. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Jihong Liu

Authors
  1. Sudha Xirasagar
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  2. Jung-Chung Fu
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  3. Jihong Liu
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  4. Janice C. Probst
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  5. Duey-Perng Lin
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Corresponding author

Correspondence to Sudha Xirasagar.

Appendix

Appendix

See Table 4.

Table 4 Full model with all independent variables: adjusted associations between maternal national origin and birth weight/Pre-term birth (coefficient estimates and odd ratios (95% CI)
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Xirasagar, S., Fu, JC., Liu, J. et al. Neonatal Outcomes for Immigrant vs. Native-Born Mothers in Taiwan: An Epidemiological Paradox. Matern Child Health J 15, 269–279 (2011). https://doi.org/10.1007/s10995-010-0612-9

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