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

Korean J Perinatol 2013;24(3):168-179.

Published online: 19 June 2013

DOI: https://doi.org/10.14734/kjp.2013.6.3.168

Factors Influencing on Perinatal Outcomes of Asian Marriage Immigrant Women : Ten-year Experience in a Single Center

Hye Young Lee, M.D., Gi Cheol Park, M.D., Mi Kyung Kim, M.D., Oh Kyung Lee, M.D

Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea

주관책임자 : 김미경, 560-750 전라북도 전주시 완산구 서원로 365 전주 예수병원 소아청소년과 전화 : 063)230-1390, 전송: 063)230-1409 E-mail : kmik7@hanmail.net

Received 1 August 2013       Revised 18 September 2013       Accepted 23 September 2013

Copyright © 2013 Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Asian immigrant mothers, Maternal and perinatal factors, Newborn, Neonatal intensive care unit

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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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