Journal List > Korean J Perinatol > v.24(3) > 1013678

Lee, Park, Kim, and Lee: Factors Influencing on Perinatal Outcomes of Asian Marriage Immigrant Women : Ten-year Experience in a Single Center

Abstract

Purpose :

We aimed to analyze the maternal and perinatal factors associated with perinatal outcomes by examining families comprised of Korean fathers, Asian immigrant mothers, and their newborns.

Method :

Medical records of newborn infants admitted to Jeonju Jesus Hospital nursery or neonatal intensive care unit (NICU) from January 2004 to June 2013 and their Asian immigrant mothers were reviewed retrospectively. The newborns were divided into two groups depending on whether they were admitted NICU or not, and factors influencing on perinatal outcomes were compared between the two groups. The newborn were divided into the two groups, including those who did not receive inpatient care and those treated in the NICU. The differences between the two groups were analyzed.

Results :

The study included 180 newborns and 172 mothers, and 94 (52.3%) and 86 (47.7%) newborns were classified as the nursery group and the NICU group, respectively. There were no statistically significant differences between the two groups in terms of the mothers’ nationality, maternal age, maternal education level, maternal occupation, residential area, maternal height and weight, maternal weight gain during pregnancy, maternal hepatitis B antigen positivity, maternal parity, paternal age, and age gap between spouses. However, underweight maternal prepregnancy body mass index (BMI) and hemoglobin level over 11.0 g/dL were significantly more frequent in the NICU group in the comparative analysis. The NICU group showed significantly more frequent no iron supplements during pregnancy (OR=4.06) and gestational disease (OR=3.81).

Conclusion :

In cases where married immigrant mothers had underweight prepregnancy BMI, gestational disease, or no iron supplements during pregnancy, their newborns were more likely to have NICU care. Therefore, married immigrant women should have appropriate perinatal care including education about a balanced diet to maintain an appropriate body weight with ensuring an adequate iron supplements intake.

REFERENCES

1). Korea national statistical office. 2011. Population dynamics (marriage and divorce) database. Available from:. http://www.kostat.go.kr/portabl/korea/idex.action.
2). Lee JH., Hahn MH., Chung SH., Choi YS., Chang JY., Bae CW, et al. Statistic observation of marriages, births, and children in multicultural families and policy perspectives in Korea. Korean J Perintol. 2012. 23:76–86.
3). Korean women's developmental institute. National survey of multicultural families. Ministry of Gender Equality and family. 2013.
4). Jang HI., Choi JS., Song ES., Choi YY. Change in birth rate, perinatal risk factors and outcome in newborns in multicultural family: ten-year experience in one center. Neonatal Med. 2013. 20:146–54.
5). Park HO., Lim JW., Jin HS., Shin JW., Kim MH., Kim CS, et al. Comparative study of newborns of Asian immigrant and Korean women. Korea J pediatr. 2009. 52:1119–26.
crossref
6). Baek IH., Kim CS., Lee SL., Kim JI. Clinical features of marriage immigrant women and their babies in perinatal period: comparison with native parturient women and neonates. Korean J Perinatol. 2011. 22:114–21.
7). WHO expert consultation. Appropriate body-mass index for Asian populations and its impli-cations for policy and intervention strategies. Lancet. 2004. 363:157–63.
8). Choi HM. Perinatal outcomes associated with prepregnancy body mass index and weight gain during pregnancy. Korean J Obstet Gynecol. 2010. 53:981–7.
crossref
9). Yang YS., Oh KY., Park MH., Hwang IT., Jeong JH., Park JS. Effects of oral administration of iron supplements during pregnancy on maternal hemoglobin levels and birth weights. Korean J Obstet Gynecol. 2001. 44:1248–55.
10). Korea national statistical office. 2012. Population dynamics (multi-culture births) database. Available from:. http://www.kostat.go.kr/portabl/korea/idex.action.
11). Seol DH. Foreign wive's life in Korea: focusing on the policy of welfare and health. Minis-tray of Health and Welfare. 2005. 101–48.
12). Nam IS., Ahn SH. Comparison of stress, social support, and marital satisfaction of between married immigrant women in urban and rural areas. Korean J Women Health Nurs. 2011. 17:99–108.
13). Jang IS., Hwang NM., Yoon MS., Park S. Current status and factors affecting prenatal care by married immigrant women. Korean J Women Health Nurs. 2010. 16:326–35.
crossref
14). Lee KS., Han DH., Bae CW. Changes in statistical birth related to maternity and newborn over the past 15 years in Korea. Korean J Perinatol. 2011. 22:229–36.
15). Song YM., Lee JS. Investigation of the cause of low birth-rate: Focused on the change in industrial society and the expansion of the opportunity of women for social activities. Health and Social Welfare Review. Seoul: Korea institute for Health and Social Affairs. 2011. 31:27–61.
16). Kim HR. Maternal health and nutritional status of marriage based women immigrants in Korea and policy directions. Health Welfare Policy Forum. 2009. 155:50–64.
17). Park SH., Ku SY., Choi YS., Kim DW., Moon SY., Kim SH. Association between paternal age and preterm birth based on birth certificate data. Korean J Perinatol. 2005. 16:216–21.
18). Lee SH., Yoon TK., Cha KY., Kwak IP., Lee JH., Oum KB, et al. Analysis of chromosomal abnor malities of sperm from patients with advanced age by FISH method. Korean J Obstet Gynecol. 1999. 42:260–3.
19). Lian IH., Zack MM., Erickson JD. Paternal age and the occurrence of birth defects. Am J Hum Genet. 1986. 39:648–60.
20). Torrey EF., Buka S., Cannon TD., Goldstein JM., Seidman LJLiu T, et al. Paternal age as a risk factor for schizophrenia: How important is it? Schizophr Res. 2009. 114:1–5.
crossref
21). Cho JH., Ahn HS., Bae HS. The use of iron supplements of pregnant women and pregnancy outcome. Korean J Community Nutrition. 2009. 14:327–39.
22). Zeng L., Cheng Y., Dang S., Yan H., Dibley MJ., Chang S, et al. Impact of micronutrient supple mentation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomized controlled trial. BMJ. 2008. 377:1211–4.
23). Lee SL., Chang YK. A study of health related factors and food habits during pregnancy of full-term and preterm delivery. J Korean Diet Assoc. 2008. 14:77–86.
24). Murphy JF., O'Rordan J., Newcombe RG., Coles EC., Pearson JF. Relation of hemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet. 1986. 1:992–5.
25). Klebanoff MA., Shiono PH., Selby JV., Trachtenberg AI., Grauebard BI. Anemia and spontane -ous preterm birth. Am J Obstet Gynecol. 1991. 164:59–63.
26). Institute of Medicine (US). Weight gain during pregnancy: reexamining the guidelines. The Institute;2009.
27). Laura AS., Mary EC., Kelley SS., Geraldine P., Cynthia F., Cheryl BP, et al. Prepregnancy body mass index and pregnancy weight gain: association with preterm delivery. Obestet Gynecol. 2000. 96:194–200.
28). Lee JS. The factors for Korean dietery life adaptation of female immigrants in multicultural families in busan. J Korean Soc food Sic Nutr. 2012. 41:807–15.
29). Jeong S., Yim HW., Bae SH., Lee WC. Changes of hepatitis B surface antigen seroprevalence in Korea, 1998-2005. Korean J Epidemiol. 2008. 30:119–27.
crossref
30). Seo K., Park SK., Kim YT., Park O. The prevalence of HBsAg positive parturients in Korea. Korean J Obstet Gynecol. 2005. 48:2119–24.
31). Nguyen VT., McLaws ML., Dore GJ. Highly endemic hepatitis B infection in rural Vietnam. J Gastroenterol Hepatol. 2007. 22:2093–100.
crossref
32). Zhang ZW., Shimbo S., Qu JB., Liu ZM., Cai XC., Wang LQ, et al. Hepatitis B and C virus infection among adult women in Jilin province, China: an urban-rural comparison in prevalence of infection markers. Southeast Asian J Trop Med Public Health. 2000. 31:530–6.
33). Lansang MA. Epidemiology and control of hepatitis B infection: a perspective from the Philippine, Asia. Gut. 1996. 38(Suppl 2):43–7.
34). Okada K., Yarnada T., Mijakawa Y. Hepatitis B surface antigen in the serum of infants after delivery from asymptomatic carrier mothers. J Pediatr. 1975. 87:360–3.
crossref
35). Cho HY., Park YW., Kim YH., Lim JH., Moon YJ. The prognostic factor for neonatal outcomes of pregnancies with preterm premature rupture of membranes. Korean J Obstet Gynecol. 2006. 49:2529–35.
36). Kwon HS., Lee SS., Shin SH., Choi HM. Comparison of perinatal outcomes with gestational weeks and severity of disease in the preterm delivery associated with preeclampsia. Korean J Obstet Gynecol. 2008. 51:1448–56.
37). Kang CH., Kim MR., Choi MY., Kang EJ., Kim HJ., Seo SS. Clinical comparison of maternal char-acteristics and pregnancy outcomes between gestational diabetes and general obstetric popu-lation. Korean J Obstet Gynecol. 2001. 44:47885.
38). Hyung WJ., Choi HM. The relationship between idiopathic polyhydramnions and oligohy-dramnios and perinatal outcomes. Korean J Perinatol. 2006. 17:287–93.

Table1.
General Characteristics and Perinatal Factors of the Married Immigrant Women and Spouses
    N %
Nationality Vietnam 78 45.3
  Philippine 40 23.3
  Cambodia 14 8.1
  China 13 7.6
  Japan 9 5.2
  Uzbekistan 7 4.1
  India 6 3.5
  Mongolia 3 1.7
  Thailand 2 1.2
Maternal age (years) M±SD 26.1±5.1  
Maternal age distribution (years) <25 85 49.4
  25-29 51 29.7
  ≥30 36 20.9
Maternal education level Elementary school 25 16.6
  Middle school 30 19.9
  High school 57 37.7
  University 35 23.2
  Unknown 4 2.6
Occupation Housewife 141 92.2
  Others 12 7.8
Residential area City 82 47.7
  Town 90 52.3
Maternal height (cm) M±SD 156.7±4.9  
Pre pregnancy weight (kg) M±SD 50.1±7,5  
Weight at delivery (kg) M±SD 61.1±9.8  
Weight gain during M±SD 10.9±3.4  
pregnancy (kg) Low weight gain (<12 kg) 93 61.6
  Average weight gain (12-13.5 kg) 25 16.6
  High weight gain (>13.5 kg) 33 21.9
Prepregnancy BMI (kg/cm2) M±SD 20.4±2.4  
  Underweight (BMI<18.5) 33 21.9
  Normal weight (18.5≤BMI<23) 103 68.2
  Overweight (23≤BMI<25) 8 5.3
  Obese (BMI≥25) 7 4.6
Iron supplements∗ Yes 98 64.9
  No 53 35.1
Hb (g/dL) M±SD 11.1±1.6  
  <11.0 68 45.3
  ≥11.0 82 54.7
HBsAg Negative 155 90.1
  Positive 17 9.9
HBsAb Negative 64 42.1
  Positive 88 57.9
Gravidity 0 116 67.4
  ≥1 56 32.6
Abortion 0 144 83.7
  ≥1 28 16.3
Delivery type NSVD 121 70.3
  C/SEC 51 29.7
Gestational disease No 138 80.2
  Yes 34 19.9
    PROM 11 6.4
    Preeclapmsia 8 4.7
    Preterm labor 8 4.7
    Oligohydramnios or polyhydramnios 5 2.9
  Placenta previa 1 0.6
  Gestational diabetes 1 0.6
Paternal age (years) M±SD 42.1±5.8  
Paternal age ≤35 23 13.6
distribution (years) 36-44 108 63.9
  45-54 34 20.1
  ≥55 4 2.4
Age gap† (years) M±SD 16.1±7.0  
Age gap <15 55 32.5
distribution (years) 15-19 52 30.8
  ≥20 62 36.7

∗Have taking use iron supplements in pregnancy,

Age gap of spouses. Abbreviations: BMI, body mass index; Hb, hemoglobin; C/SEC, caesarean section; PROM, premature rupture of membranes.

Table 2.
Comparison of Normal Newborn and Newborn Admitted to Neonatal Intensive Care Unit
    NB group n (%) NICU group n (%) P-value
GA (weeks) M±SD 39.2±1.0 36.5±2.9 <0.001
Gender Male 55 (58.5) 50 (58.1) 0.960
  Female 39 (41.5) 36 (41.9) 0.960
BW (g) M±SD 3,114.3±337.8 2,533.0±669.6 <0.001
BW for GA SAG 1 (1.1) 10 (11.6) 0.003
  AGA 93 (98.9) 74 (86.0) 0.001
  LGA 0 (0.0) 2 (2.3) 0.137
Birth height (cm) M±SD 49.4±1.8 45.5±4.1 <0.001
Birth head circumference (cm) M±SD 33.8±1.0 32.1±2.5 <0.001
Apgar score (1 min) M±SD 9.0±0.2 8.1±1.8 <0.001
Apgar score (5 min) M±SD 9.9±0.2 9.2±1.5 <0.001

Abbreviation: GA, Gestational age; BW, Birth weight; SGA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age.

Table 3.
Underlying Diseases of Newborn Admitted to Neonatal Intensive Care Unit
  n %
Prematurity 39 45.3
Pulmonary∗ 9 10.5
Hyperbilirubinemia 8 9.3
SGA 8 9.3
Sepsis like illness 6 6.9
Congenital infection 4 4.7
Perinatal asphyxia 4 4.7
Seizure 3 3.5
MAS 2 2.3
Others 3 3.5

∗Pulmonary: Respiratory distress syndrome, transient tachypnea of newborn, and congenital pneumonia.

Congenital infection: Congenital syphilis and congenital rubella syndrome.

Defined as pH of arterial blood <0.7 and Apgar scores at 1 min ≤5.

Others: Bradycardia, large for gestational age, and meningocele. Abbreviation: SGA, small for gestational age; MAS, meconium aspiration syndrome.

Table 4.
Comparison of Characteristics and Perinatal Factors between Normal Newborns and Newborns Admitted to Neonatal Intensive Care Unit
    NB group n(%) NICU group n (%) P-value
Nationality Vietnam 41 (44.6) 37 (46.3) 0.825
  Philippine 20 (21.7) 20 (25.0) 0.614
  Cambodia 11 (12.0) 3 (3.8) 0.050
  Japan 6 (6.5) 3 (3.8) 0.416
  China 5 (5.4) 8 (10.0) 0.259
  Uzbekistan 4 (4.3) 3 (3.8) 0.843
  India 3 (3.3) 3 (3.8) 0.862
  Mongolia 1 (1.1) 2 (2.5) 0.480
  Thailand 1 (1.1) 1 (1.3) 0.921
Maternal age (years) M±SD 25.9±5.1 26.3±5.1 0.610
Maternal age distribution (year rs) <25 46 (50.0) 39 (48.8) 0.870
  25-29 27 (29.3) 24 (30.0) 0.926
  ≥30 19 (20.7) 17 (21.3) 0.923
Maternal education level Elementary school 15 (16.3) 10 (16.9) 0.917
  Middle school 17 (18.5) 13 (22.0) 0.593
  High school 40 (43.5) 17 (28.8) 0.070
  University 16 (17.4) 19 (32.2) 0.035
  Unknown 4 (4.3) 0 (0.0) 0.105
Occupation Housewife 87 (94.6) 54 (88.5) 0.174
  Others 5 (5.4) 7 (11.5) 0.174
Residential area City 49 (53.3) 33 (41.3) 0.116
  Town 43 (46.7) 47 (58.8) 0.116
Maternal height (cm) M±SD 156.9±5.0 156.3±4.8 0.508
Pre pregnancy weight (kg) M±SD 50.7±6.8 49.2±8.3 0.221
Weight at delivery (kg) M±SD 61.9±8.6 59.8±11.4 0.216
Weight gain during M±SD 11.1±3.0 10.6±3.8 0.380
Pregnancy (kg) Low weight gain (<12 kg) 51 (55.4) 42 (71.2) 0.052
  Average weight gain (12-13.5 5 kg) 18 (19.6) 7 (11.9) 0.214
  High weight gain (>13.5 kg) 23 (25.0) 10 (16.9) 0.243
Prepregnancy BMI (kg/cm2) M±SD 20.6±2.4 20.1±2.4 0.187
  Underweight (BMI<18.5) 13 (14.1) 20 (33.9) 0.004
  Normal weight (18.5≤BMI<23) 68 (73.9) 35 (59.3) 0.060
  Overweight (23≤BMI<25) 6 (6.5) 2 (3.4) 0.402
  Obese (BMI≥25) 5 (5.4) 2 (3.4) 0.560
Iron supplements Yes 71 (77.2) 27 (45.8) <0.001
  No 21 (22.8) 32 (54.2) <0.001
Hb (g/dL) M±SD 11.0±1.6 11.4±1.6 0.151
  <11.0 48 (52.2) 20 (34.5) 0.034
  ≥11.0 44 (47.8) 38 (65.5) 0.034
HBsAg Negative 82 (89.1) 7 3(91.3) 0.642
  Positive 10 (10.9) 7 (8.8) 0.642
HBsAb Negative 39 (42.4) 25 (41.7) 0.930
  Positive 53 (57.6) 35 (58.3) 0.930
Gravidity 0 57 (62.0) 59 (73.8) 0.100
  ≥1 35 (38.0) 21 (26.3) 0.100
Abortion 0 76 (82.6) 68 (85.0) 0.672
  ≥1 16 (17.4) 12 (15.0) 0.672
Delivery type NSVD 71 (77.2) 50 (62.5) 0.036
  C/SEC 21 (22.8) 30 (37.5) 0.036
Gestational disease No 85 (92.4) 53 (66.3) <0.001
  Yes 7 (7.6) 27 (33.8) <0.001
Paternal age (years) M±SD 41.7±5.6 42.6±6.1 0.352
Paternal age distribution (years) ≤35 12 (13.0) 11 (14.3) 0.815
  36-44 63 (68.5) 45 (58.4) 0.176
  45-54 15 (16.3) 19 (24.7) 0.176
  ≥55 2 (2.2) 2 (2.6) 0.857
Age gap (years) M±SD 15.8±6.7 16.4±7.3 0.564
Age gap <15 32 (34.8) 23 (29.9) 0.497
distribution (years) 15-19 29 (31.5) 23 (29.9) 0.817
  ≥20 31 (33.7) 31 (40.3) 0.378

∗Have taking use iron supplements in pregnancy;

Gestational disease: preeclampsia, gestational diabetes, preterm labor, premature rupture of membranes, placenta previa, oligohydramnions, and polyhydramnios;

Age gap of spouses. Abbreviations: BMI, body mass index; Hb, hemoglobin; C/SEC, caesarean section.

Table 5.
Logistric Regression Analysis for Normal Newborns and Newborns Admitted to Neonatal Intensive Care Unit
Independent variables Dependent variables NICU group∗
Adjusted OR 95% CI P-value
B BMI <18.5 (kg/cm2) 3.29 1.30-8.36 0.012
Iron supplements 4.39 1.95-9.87 <0.001
Hb <11.0 (g/dL) 2.34 1.05-5.22 0.038
Gestational disease∗∗ 7.00†† 2.58-19.04 <0.001

∗NB group served as the reference group.

Adjusted for gestational age, birth weight, and birth height.

NICU group adjusted for maternal age, method of delivery, gestational disease, Hb level, and use of iron supplements.

Have taking use iron supplements in pregnancy.

NICU group adjusted for maternal age, method of delivery, gestational disease, Hb level, and prepragnancy body mass index.

NICU group adjusted for maternal age, method of delivery, gestational disease, Hb level, use of iron supplements, and prepragnancy body mass index. ∗∗Gestational disease: preeclampsia, gestational diabetes, preterm labor, premature rupture of membranes, placenta previa, oligohydramnions, and polyhydramnios.

†† NICU group adjusted for maternal age, method of delivery, gestational disease, Hb level. Use iron supplements, and prepragnancy body mass index Abbreviations: BMI, body mass index; Hb, hemoglobin; OR, Odds Ratio;CI,Confidence Interval.

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