{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:35:24Z","timestamp":1782189324594,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004041","name":"Perinatal Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>One in four women giving birth in Sweden is foreign\u2010born. Immigrant status has been suggested as a risk factor for adverse perinatal outcomes. It is not known if infants to foreign\u2010born women have an increased risk of severe birth asphyxia, or which factors might mediate such association.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A population\u2010based cohort study of 726\u00a0730\u00a0live births at 36\u00a0weeks of gestation or more in Sweden in 2009\u20132015. The exposure was maternal country of birth, grouped according to the World Bank country classification: low\u2010, lower\u2010middle, upper\u2010middle, and high\u2010income economies. The main outcome was neonatal hypoxic ischemic encephalopathy (HIE). The outcome was estimated by severity and classified as non\u2010hypothermia\u2010treated HIE, representing mainly mild cases, and hypothermia\u2010treated HIE, representing moderate to severe cases. A secondary outcome was low Apgar score at 5\u00a0minutes, defined as &lt;7 or &lt;4. Odds ratios with 95% CI were calculated, using Swedish\u2010born women as the reference. Structural equation modeling was used to investigate potential mediation of known antepartum risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 854 infants were diagnosed with HIE and 398 received therapeutic hypothermia. Offspring of mothers born in low\u2010income countries had the highest incidences of HIE and low Apgar score, with an incidence of therapeutic hypothermia of 1.1 per 1000. Compared with offspring of Swedish\u2010born mothers, these neonates had an almost two\u2010fold increased risk of HIE, with or without hypothermia treatment (odds ratio 1.7; 95% CI 1.2\u20132.7 and odds ratio 1.7; 95% CI 1.2\u20132.6, respectively), and a 2\u2010 to 3\u2010fold increased risk of low Apgar score. The structural equation model analysis indicated an exclusive direct effect of country of birth on HIE. Factors reflecting socio\u2010economic status mediated a small proportion of the risk of Apgar score &lt;7 at 5\u00a0minutes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Offspring of women born in low\u2010income countries had associations with severe birth asphyxia, with increased risk of both HIE and low Apgar score at 5\u00a0minutes. The associations seemed only to be marginally mediated by other antepartum factors. The associations are complex and further studies are needed to find explanatory and potentially preventable factors.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14234","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T18:01:49Z","timestamp":1626890509000},"page":"2285-2293","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Hypoxic ischemic encephalopathy in offspring of immigrant women in Sweden: A population\u2010based cohort study"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6904-8115","authenticated-orcid":false,"given":"Anna E.","family":"T\u00f6rn","sequence":"first","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Lampa","sequence":"additional","affiliation":[{"name":"Department of Medical Science Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-3303","authenticated-orcid":false,"given":"Anna\u2010Karin","family":"Wikstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-1958","authenticated-orcid":false,"given":"Maria","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Socialstyrelsen.\u00d6ppna j\u00e4mf\u00f6relser J\u00e4mlik v\u00e5rd 2016 Kvinnors h\u00e4lso\u2010 och sjukv\u00e5rd F\u00f6rdjupningsrapport. 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