{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T01:38:56Z","timestamp":1793065136093,"version":"4.5.0"},"reference-count":68,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414\u202f337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks\u2019 gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal health care insurance. Statistical analysis was performed from December 2021 to March 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Nonrefugee immigrant status vs nonimmigrant status.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or \u22653 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort included 148\u202f085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266\u202f252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52\u202f447 [35.4%]) and the East Asia and Pacific (35\u202f280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148\u202f085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266\u202f252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of \u22121.5 per 1000 births (95% CI, \u22122.3 to \u22120.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.56203","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T16:01:15Z","timestamp":1676563275000},"page":"e2256203","source":"Crossref","is-referenced-by-count":12,"title":["Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada"],"prefix":"10.1001","volume":"6","author":[{"given":"Jennifer A.","family":"Jairam","sequence":"first","affiliation":[{"name":"Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone 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