Do mother's education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect

N. Auger, Z. C. Luo, R. W. Platt, M. Daniel

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Introduction: The unresolved "epidemiological paradox" concerns the association between low socioeconomic status and unexpectedly favourable birth outcomes in foreign born mothers. The "healthy migrant" effect concerns the association between foreign born status per se and birth outcomes. The epidemiological paradox and healthy migrant effect were analysed for newborns in a favourable sociopolitical environment. Methods: 98 330 live births to mothers in Montreal, Canada from 1997 to 2001 were analysed. Mothers were categorised as foreign born versus Canadian born. Outcomes were: small for gestational age (SGA) birth; low birth weight (LBW) and preterm birth (PTB). Multilevel logistic regression was used to examine the interaction between maternal education and foreign born status, adjusting for covariates. Results: Not having a high school diploma was associated with LBW in Canadian (odds ratio (OR) 3.20; 95% CI 2.61 to 3.91) but not foreign born (OR 1.14; 95% CI 0.99 to 2.10) mothers and was more strongly associated with SGA birth in Canadian (OR 2.03; 95% CI 1.84 to 2.22) than in foreign born (OR 1.26; 95% CI 1.07 to 1.49) mothers. Foreign born status was associated with SGA birth (OR 1.37; 95% CI 1.28 to 1.47), LBW (OR 1.51; 95% CI 1.27 to 1.79) and PTB (OR 1.12; 95% CI 1.03 to 1.22) in university-educated mothers only. Conclusions: The epidemiological paradox associated with low educational attainment was present for SGA birth and LBW but not PTB. Foreign born status was associated with adverse birth outcomes in university-educated mothers, the opposite of the healthy migrant effect.

Original languageEnglish
Pages (from-to)402-409
Number of pages8
JournalJournal of Epidemiology and Community Health
Volume62
Issue number5
DOIs
Publication statusPublished - 2008
Externally publishedYes

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Mothers
Parturition
Education
Odds Ratio
Low Birth Weight Infant
Gestational Age
Premature Birth
Live Birth
Social Class
Canada
Logistic Models
Newborn Infant

Cite this

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title = "Do mother's education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect",
abstract = "Introduction: The unresolved {"}epidemiological paradox{"} concerns the association between low socioeconomic status and unexpectedly favourable birth outcomes in foreign born mothers. The {"}healthy migrant{"} effect concerns the association between foreign born status per se and birth outcomes. The epidemiological paradox and healthy migrant effect were analysed for newborns in a favourable sociopolitical environment. Methods: 98 330 live births to mothers in Montreal, Canada from 1997 to 2001 were analysed. Mothers were categorised as foreign born versus Canadian born. Outcomes were: small for gestational age (SGA) birth; low birth weight (LBW) and preterm birth (PTB). Multilevel logistic regression was used to examine the interaction between maternal education and foreign born status, adjusting for covariates. Results: Not having a high school diploma was associated with LBW in Canadian (odds ratio (OR) 3.20; 95{\%} CI 2.61 to 3.91) but not foreign born (OR 1.14; 95{\%} CI 0.99 to 2.10) mothers and was more strongly associated with SGA birth in Canadian (OR 2.03; 95{\%} CI 1.84 to 2.22) than in foreign born (OR 1.26; 95{\%} CI 1.07 to 1.49) mothers. Foreign born status was associated with SGA birth (OR 1.37; 95{\%} CI 1.28 to 1.47), LBW (OR 1.51; 95{\%} CI 1.27 to 1.79) and PTB (OR 1.12; 95{\%} CI 1.03 to 1.22) in university-educated mothers only. Conclusions: The epidemiological paradox associated with low educational attainment was present for SGA birth and LBW but not PTB. Foreign born status was associated with adverse birth outcomes in university-educated mothers, the opposite of the healthy migrant effect.",
author = "N. Auger and Luo, {Z. C.} and Platt, {R. W.} and M. Daniel",
year = "2008",
doi = "10.1136/jech.2007.064535",
language = "English",
volume = "62",
pages = "402--409",
journal = "Journal of Epidemiology Community Health",
issn = "0143-005X",
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TY - JOUR

T1 - Do mother's education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect

AU - Auger, N.

AU - Luo, Z. C.

AU - Platt, R. W.

AU - Daniel, M.

PY - 2008

Y1 - 2008

N2 - Introduction: The unresolved "epidemiological paradox" concerns the association between low socioeconomic status and unexpectedly favourable birth outcomes in foreign born mothers. The "healthy migrant" effect concerns the association between foreign born status per se and birth outcomes. The epidemiological paradox and healthy migrant effect were analysed for newborns in a favourable sociopolitical environment. Methods: 98 330 live births to mothers in Montreal, Canada from 1997 to 2001 were analysed. Mothers were categorised as foreign born versus Canadian born. Outcomes were: small for gestational age (SGA) birth; low birth weight (LBW) and preterm birth (PTB). Multilevel logistic regression was used to examine the interaction between maternal education and foreign born status, adjusting for covariates. Results: Not having a high school diploma was associated with LBW in Canadian (odds ratio (OR) 3.20; 95% CI 2.61 to 3.91) but not foreign born (OR 1.14; 95% CI 0.99 to 2.10) mothers and was more strongly associated with SGA birth in Canadian (OR 2.03; 95% CI 1.84 to 2.22) than in foreign born (OR 1.26; 95% CI 1.07 to 1.49) mothers. Foreign born status was associated with SGA birth (OR 1.37; 95% CI 1.28 to 1.47), LBW (OR 1.51; 95% CI 1.27 to 1.79) and PTB (OR 1.12; 95% CI 1.03 to 1.22) in university-educated mothers only. Conclusions: The epidemiological paradox associated with low educational attainment was present for SGA birth and LBW but not PTB. Foreign born status was associated with adverse birth outcomes in university-educated mothers, the opposite of the healthy migrant effect.

AB - Introduction: The unresolved "epidemiological paradox" concerns the association between low socioeconomic status and unexpectedly favourable birth outcomes in foreign born mothers. The "healthy migrant" effect concerns the association between foreign born status per se and birth outcomes. The epidemiological paradox and healthy migrant effect were analysed for newborns in a favourable sociopolitical environment. Methods: 98 330 live births to mothers in Montreal, Canada from 1997 to 2001 were analysed. Mothers were categorised as foreign born versus Canadian born. Outcomes were: small for gestational age (SGA) birth; low birth weight (LBW) and preterm birth (PTB). Multilevel logistic regression was used to examine the interaction between maternal education and foreign born status, adjusting for covariates. Results: Not having a high school diploma was associated with LBW in Canadian (odds ratio (OR) 3.20; 95% CI 2.61 to 3.91) but not foreign born (OR 1.14; 95% CI 0.99 to 2.10) mothers and was more strongly associated with SGA birth in Canadian (OR 2.03; 95% CI 1.84 to 2.22) than in foreign born (OR 1.26; 95% CI 1.07 to 1.49) mothers. Foreign born status was associated with SGA birth (OR 1.37; 95% CI 1.28 to 1.47), LBW (OR 1.51; 95% CI 1.27 to 1.79) and PTB (OR 1.12; 95% CI 1.03 to 1.22) in university-educated mothers only. Conclusions: The epidemiological paradox associated with low educational attainment was present for SGA birth and LBW but not PTB. Foreign born status was associated with adverse birth outcomes in university-educated mothers, the opposite of the healthy migrant effect.

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U2 - 10.1136/jech.2007.064535

DO - 10.1136/jech.2007.064535

M3 - Article

VL - 62

SP - 402

EP - 409

JO - Journal of Epidemiology Community Health

JF - Journal of Epidemiology Community Health

SN - 0143-005X

IS - 5

ER -