{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T04:13:17Z","timestamp":1747282397354,"version":"3.40.5"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec020\">\n<jats:title>Background<\/jats:title>\n<jats:p>The association between migration and pregnancy outcomes gives contradictory results. Women\u2019s socio-economic status explains some differences, but its influence may vary according to women\u2019s underlying health conditions. Our aim was to understand how comorbidities modify the relationship between migration and preterm birth or small for gestational age in Belgium.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec021\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data are related to all singleton births to women living in Belgium between 2010 and 2019 (n\u2009=\u20091 200 417). Maternal nationalities were grouped as Belgium, European Union, Eastern Europe, North Africa, Sub-Saharan Africa and the Middle East. A logistic regression was used to estimate the association between maternal nationalities and perinatal outcomes, taking into account the socio-economic status and maternal comorbidities: hypertension, obesity, and diabetes. The interaction effect between maternal nationalities and comorbidities was tested.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec022\">\n<jats:title>Results<\/jats:title>\n<jats:p>Migrant women were more socio-economically disadvantaged than Belgian women. All migrant women without hypertension had a significantly lower Odd Ratio of preterm birth and small for gestational age than Belgian (p\u2009&lt;\u20090.001). In contrast, women with hypertension had a higher OR than Belgian women, even after adjustment for socio-economic status and other comorbidities. This difference was more striking among Sub-Saharan African and Middle Eastern women: respectively, aORs 1.45 (95%CI 1.30\u20131.62) and 1.24 (95%CI 1.01\u20131.54) for preterm birth, and aORs 1.17 (95%CI 1.03\u20131.17) and 1.28 (95%CI 1.02\u20131.60) for small for gestational age.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec023\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Hypertension modifies the association between migration and unfavourable pregnancy outcomes. Although migrant women had a lower risk of preterm birth and small for gestational age than Belgian women, in the presence of hypertension, their risk was significantly higher than Belgian women with the same conditions. Further research is needed to analyse the complex relationships between migration, social status, women\u2019s living conditions, and perinatal outcome.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323652","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T17:33:07Z","timestamp":1747243987000},"page":"e0323652","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypertension as an effect modifier for preterm and small for gestational age births in migrant women in Belgium: A population-based study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5015-7987","authenticated-orcid":true,"given":"Clotilde","family":"Lamy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amira","family":"Doghri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4044-9799","authenticated-orcid":true,"given":"Elena","family":"Costa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9536-3071","authenticated-orcid":true,"given":"Michel","family":"Boulvain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Hocquette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Racap\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"key":"pone.0323652.ref001","author":"Demography of Europe"},{"issue":"6","key":"pone.0323652.ref002","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.socscimed.2009.06.027","article-title":"Migration to western industrialised countries and perinatal health: a systematic review","volume":"69","author":"ROAM Collaboration","year":"2009","journal-title":"Soc Sci Med"},{"issue":"3","key":"pone.0323652.ref003","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.socscimed.2008.10.018","article-title":"Pregnancy outcome of migrant women and integration policy: a systematic review of the international literature","volume":"68","author":"P Bollini","year":"2009","journal-title":"Soc Sci Med"},{"issue":"5","key":"pone.0323652.ref004","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1093\/eurpub\/ckq060","article-title":"High perinatal mortality rate among immigrants in Brussels","volume":"20","author":"J Racape","year":"2010","journal-title":"Eur J Public Health"},{"key":"pone.0323652.ref005","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1186\/s12884-021-04183-9","article-title":"Measuring the invisible: perinatal health outcomes of unregistered women giving birth in Belgium, a population-based study","volume":"21","author":"C Schoenborn","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0323652.ref006","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1186\/s12884-018-2043-3","article-title":"Is the socioeconomic status of immigrant mothers in Brussels relevant to predict their risk of adverse pregnancy outcomes?","volume":"18","author":"M Sow","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0323652.ref007","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s12884-016-0860-9","article-title":"Are all immigrant mothers really at risk of low birth weight and perinatal mortality? The crucial role of socio-economic status","volume":"16","author":"J Racape","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"issue":"4","key":"pone.0323652.ref008","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1097\/AOG.0000000000005342","article-title":"Chronic Hypertension in Pregnancy and Racial-Ethnic Disparities in Complications","volume":"142","author":"SA Leonard","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"12","key":"pone.0323652.ref009","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1111\/1471-0528.14658","article-title":"Exploring the hypothesis of differential care for African immigrant and native women in France with hypertensive disorders during pregnancy: a qualitative study","volume":"124","author":"P Sauvegrain","year":"2017","journal-title":"BJOG"},{"key":"pone.0323652.ref010","doi-asserted-by":"crossref","first-page":"109050","DOI":"10.1016\/j.diabres.2021.109050","article-title":"IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group\u2019s Criteria","volume":"183","author":"H Wang","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"issue":"9","key":"pone.0323652.ref011","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1007\/s00038-018-1146-y","article-title":"The perinatal health of immigrant women in France: a nationally representative study","volume":"63","author":"F El-Khoury Lesueur","year":"2018","journal-title":"Int J Public Health"},{"issue":"6","key":"pone.0323652.ref012","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1111\/j.1365-3016.2011.01230.x","article-title":"International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis","volume":"25","author":"AJ Gagnon","year":"2011","journal-title":"Paediatr Perinat Epidemiol"},{"key":"pone.0323652.ref013","author":"CEpiP"},{"key":"pone.0323652.ref014"},{"issue":"4","key":"pone.0323652.ref015","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1023\/A:1022328020935","article-title":"Birth outcomes of immigrant women in the United States, France, and Belgium","volume":"3","author":"S Guendelman","year":"1999","journal-title":"Matern Child Health J"},{"issue":"1","key":"pone.0323652.ref016","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s10903-015-0317-7","article-title":"Revisiting the Healthy Migrant Paradox in Perinatal Health Outcomes Through a Scoping Review in a Recent Host Country","volume":"19","author":"SP Ju\u00e1rez","year":"2017","journal-title":"J Immigr Minor Health"},{"issue":"10","key":"pone.0323652.ref017","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/j.socscimed.2012.02.013","article-title":"Revisiting the immigrant paradox in reproductive health: the roles of duration of residence and ethnicity","volume":"74","author":"ML Urquia","year":"2012","journal-title":"Soc Sci Med"},{"issue":"9873","key":"pone.0323652.ref018","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/S0140-6736(12)62086-8","article-title":"Migration and health in an increasingly diverse Europe","volume":"381","author":"B Rechel","year":"2013","journal-title":"Lancet"},{"key":"pone.0323652.ref019","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.psychres.2018.06.039","article-title":"Immigrants and mental disorders in the united states: New evidence on the healthy migrant hypothesis","volume":"267","author":"CP Salas-Wright","year":"2018","journal-title":"Psychiatry Res"},{"key":"pone.0323652.ref020","article-title":"Racial and Ethnic Disparities among Pregnancies with Chronic Hypertension and Adverse Outcomes","volume":"41","author":"M Fishel Bartal","year":"2024","journal-title":"Am J Perinatol"},{"issue":"19","key":"pone.0323652.ref021","doi-asserted-by":"crossref","first-page":"6941","DOI":"10.3390\/ijerph17196941","article-title":"Racial Differences in the Biochemical Effects of Stress in Pregnancy","volume":"17","author":"P Ekeke","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0323652.ref022","doi-asserted-by":"crossref","first-page":"5215","DOI":"10.1038\/s41598-020-62032-9","article-title":"Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis","volume":"10","author":"A Siddiqui","year":"2020","journal-title":"Sci Rep"},{"key":"pone.0323652.ref023","author":"EMN","year":"2024"},{"issue":"2","key":"pone.0323652.ref024","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s10903-019-00897-3","article-title":"Urgent Medical Aid and Associated Obstetric Mortality in Belgium","volume":"22","author":"C Vanneste","year":"2020","journal-title":"J Immigr Minor Health"},{"issue":"1","key":"pone.0323652.ref025","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s10900-017-0381-0","article-title":"Health Literacy and Associated Factors Among Hmong American Immigrants: Addressing the Health Disparities","volume":"43","author":"BP Khuu","year":"2018","journal-title":"J Community Health"},{"issue":"2","key":"pone.0323652.ref026","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/jmwh.13580","article-title":"Communication Between Pregnant People of Color and Prenatal Care Providers in the United States: An Integrative Review","volume":"69","author":"AH Goh","year":"2024","journal-title":"J Midwifery Womens Health"},{"issue":"3","key":"pone.0323652.ref027","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1093\/eurpub\/ckad078","article-title":"Association between language barrier and inadequate prenatal care utilization among migrant women in the PreCARE prospective cohort study","volume":"33","author":"M Eslier","year":"2023","journal-title":"Eur J Public Health"},{"issue":"4","key":"pone.0323652.ref028","doi-asserted-by":"crossref","first-page":"102340","DOI":"10.1016\/j.jogoh.2022.102340","article-title":"Implicit biases and differential perinatal care for migrant women: Methodological framework and study protocol of the BiP study part 3\u2730,\u2730\u2730","volume":"51","author":"E Azria","year":"2022","journal-title":"J Gynecol Obstet Hum Reprod"},{"key":"pone.0323652.ref029","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.socscimed.2018.02.013","article-title":"Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth","volume":"201","author":"MR McLemore","year":"2018","journal-title":"Soc Sci Med"},{"key":"pone.0323652.ref030","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1186\/s12889-022-13246-1","article-title":"Ability of municipality-level deprivation indices to capture social inequalities in perinatal health in France: A nationwide study using preterm birth and small for gestational age to illustrate their relevance","volume":"22","author":"Y Barry","year":"2022","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0323652.ref031","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12978-019-0729-2","article-title":"The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States","volume":"16","author":"S Vedam","year":"2019","journal-title":"Reprod Health"},{"key":"pone.0323652.ref032","unstructured":"Black maternal health: Government Response to the Committee\u2019s Third Report."},{"issue":"1","key":"pone.0323652.ref033","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1186\/s12884-022-04937-z","article-title":"Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers","volume":"22","author":"R Ewesesan","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"4","key":"pone.0323652.ref034","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1177\/1049732316645319","article-title":"Illness Narratives of African Americans Living With Coronary Heart Disease: A Critical Interactionist Analysis","volume":"27","author":"L Dubbin","year":"2017","journal-title":"Qual Health Res"},{"issue":"1","key":"pone.0323652.ref035","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/emph\/eoad007","article-title":"Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health","volume":"11","author":"P Ivey Henry","year":"2023","journal-title":"Evol Med Public Health"},{"key":"pone.0323652.ref036","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.whi.2018.06.002","article-title":"Experiences of Racism and Preterm Birth: Findings from a Pregnancy Risk Assessment Monitoring System, 2004 through 2012","volume":"28","author":"KM Bower","year":"2018","journal-title":"Womens Health Issues"},{"key":"pone.0323652.ref037","year":"2020"},{"issue":"2","key":"pone.0323652.ref038","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.ejogrb.2012.12.039","article-title":"Effect of adopting host-country nationality on perinatal mortality rates and causes among immigrants in Brussels","volume":"168","author":"J Racape","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"4","key":"pone.0323652.ref039","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0267098","article-title":"Country of birth as a potential determinant of inadequate antenatal care use among women giving birth in Brussels. A cross-sectional study","volume":"17","author":"C Sch\u00f6nborn","year":"2022","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323652","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T17:33:18Z","timestamp":1747243998000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323652"}},"subtitle":[],"editor":[{"given":"Renato Teixeira","family":"Souza","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,14]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323652","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,14]]}}}