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- Maternal care experience and postpartum depressive symptoms among migrant and native in PortugalPublication . Teixeira, Cristina; Santos, Susana; Guerra, João; Barros, HenriqueMigration is a risk factor for both, poor maternal experience with healthcare services (MEHCS) and postpartum depressive symptoms (PPDS), a matter of concern due to their adverse consequences. We aimed to assess the association between MEHCS and PPDS taking into account the migration status. Methods: This is part of a population-based study (baMBINO project), enrolling native (PT; n = 1568), permanent migrant (PM; n = 676) and temporary migrant (TM; n = 757) women recruited at delivery (2017-2019) in 32 Portuguese public hospitals. MEHCS was assessed based on 39 items of the Migrant Friendly Maternal Care Questionnaire asking about how women have experienced maternal care during pregnancy, during delivery and after birth. Items were grouped into 9 components each one assessing a different issue of MEHCS. For each component women were classified as having ‘‘good’’ or ‘‘less than good’’ experience. PPDS were assessed using the Edinburgh Postnatal Depression Scale (cut-off>12).Multivariate logistic regression model was fitted to estimate the association between MEHCS and PPDS. Adjusted odds ratio (aOR) and respective 95% confidence interval were obtained. Results: PPDS were reported by 3.8%, 5.8% and 8.2% of PT, PM and TM women, respectively (p < 0.001). After adjustment, 4 out 9 components of MEHCS appeared related with PPDS, such that women reporting less than good experience with ‘‘under standing information’’ (aOR = 1.72 95%CI:1.14-2.60), ‘‘decisions according to maternal wishes’’ (aOR = 1.56 95% CI:1.04-2.34), ‘‘time waiting for healthcare’’ (aOR = 1.50 95%CI:1.04-2.18) and ‘‘healthcare provider’s attitudes during pregnancy’’ (aOR = 1.58 95%CI:1.01-2.47) showed higher odds of PPDS than women reporting good experience. Conclusions: Further than the migration status, poor experience with some issues of maternal care seems play a role in the risk of PPDS Key messages: Awareness should be given to maternal care experience. Public health strategies should address factors underlying a positive maternal experience.
- Tobacco use during pregnancy among native and migrant women in Portugal. Results from the bambino studyPublication . Teixeira, Cristina; Al Hamwi, Sousan; Carrapatoso, Mariana; Lisi, Cosima; Lopes, Sofia; Barros, Henrique; Cancela, MarilyneTobacco use is a major modifiable risk factor of adverse maternal and fetal health outcomes. Being a migrant has been associated with lower risk of smoking during pregnancy. However, it remains a matter of debate whether such association could be explained by other socio-demographic characteristics or whether such effect remains or increases according to the length of stay in the host country. This study examined the differences in maternal smoking prevalence between native, long-term and recent migrant women in Portugal. METHODS: This study was derived from baMBINO, a national project grounded on 32 public maternity units in mainland Portugal aiming to investigate the differences in perinatal healthcare and outcomes among migrant and native women. Recruitment took place during admission for delivery, inviting both native and foreign-born women. Participants included in this analysis (n=1107) were classified according to their country of birth and length of stay in Portugal into: native (Portuguese-born), recent migrant (foreign-born women who spent 10 years or less in Portugal), and long-term migrants (foreign-born women who spent more than 10 years in Portugal). Logistic regression model was fitted to estimate the association between the aforementioned migration statuses and having or not smoked tobacco during pregnancy, taking into account women’s age, parity, marital status, level of education, family income, country of origin of women’s parents and gestational age at the first prenatal care visit. Adjusted odds-ratio (OR) and respective 95% confidence interval (95%CI) were obtained. RESULTS: A little over half of the study participants were foreign-born and almost 60% of those were recent migrants. Tobacco smoking during pregnancy was evidently more prevalent among native women than among long-term or recent migrant women (14% vs. 8% and 4% respectively; p<0.001). Compared to native women, both long-term and recent migrant women were more likely to be unmarried, have a family income lower than 1000€, and have their first prenatal visit after 12 weeks of gestation. Long-term migrants were more likely to have Portuguese-born parents than recent migrants (26.0% vs. 2.5%; p<0.001). According to the multivariate regression model, having a higher educational level was significantly associated with not smoking during pregnancy (secondary school: OR=0.38; 95%CI:0.23–0.62; postgraduate education: OR=0.18; 95%CI:0.09–0.35), opposed to women who have 9 or less years of education. However no association was observed between smoking during pregnancy and maternal age (OR=1.10; 95%CI:0.60–2.01 and OR=0.95; 95%CI:0.57–1.58 for women aged less than 25 and 35 or more years, respectively, in comparison with women aged 25-34 years), family income (OR=1.30; 95%CI:0.77–2.18 for women with higher income), parity (OR=0.68; 95%CI:0.43–1.09 for multiparous in comparison with primiparous women), gestational age at first prenatal visit (OR=1.12, 95%CI:0.59–2.11 for women having their first prenatal visit after 12 weeks), having a foreign-born parent (yes vs no: OR=0.83; 95%CI:0.43–1.63) and marital status (single vs married women: OR=0.76; 95%CI:0.46–1.24). Smoking during pregnancy was significantly less frequent in recent and long-term migrants (OR=0.24; 95%CI:0.10-0.57, OR=0.52, 95%CI: 0.25-1.09 respectively) compared with native Portuguese women. CONCLUSION: Results of this study demonstrated significant disparities in the prevalence of maternal smoking during pregnancy according to the women’s place of birth and duration of stay in Portugal. Native-born women had a higher risk of smoking during pregnancy than foreign-born women. The increase in the duration of stay in the host country seemed to have a negative effect on maternal smoking of migrants in Portugal. Smoking cessation health strategies in pregnant women in Portugal need to be improved by taking into account the mentioned variations in smoking behaviors.
- Marketing of breastmilk substitutes and early breastfeeding practices among native and migrant womenPublication . Lisi, Cosima; Teixeira, Cristina; Al Hamwi, Sousan; Rodrigues, Carina; Lopes, Sofia; Barros, HenriqueThere is a large body of evidence regarding the benefits of breastfeeding for mothers and their children. However, the influence of marketing of breastmilk substitutes on breastfeeding practices remains a big concern. The aim of this study is to examine the association between exposure to different breastmilk substitutes market factors and never breastfeeding or dropping exclusive breastfeeding within 1 month postpartum, comparing migrant with native women. Methods: This study is part of the project baMBINO, an ongoing research on perinatal health among migrant and native women in Portugal. Women with a live-birth and aged ≥ 18 years were recruited in 32 Portuguese public hospitals during admission for delivery. Data on breastfeeding practices and exposure to market factors were collected by telephone interviews at 1-3 months postpartum. According to their feeding practices within 1 month after delivery, women were classified into two categories: those who have never breastfed or have dropped exclusive breastfeeding, and those who have maintained exclusive breastfeeding. Five market factors were assessed: free samples, discounts, television, newspaper/magazine, and shop/ pharmacy advertisement. Logistic regression models were used to study the association between each market factor and early breastfeeding practices, adjusting for maternal age, education, parity, mode of delivery, and skin-to-skin contact in the first hour after birth. All analyses were stratified by women’s country of birth (native vs. migrant). Adjusted odds-ratio (aOR) and a respective 95% confidence interval (95%CI) were obtained. Results: Out of 539 natives and an equal number of migrant women, 43.4% and 36.7%, respectively, have either never breastfed or dropped exclusive breastfeeding within 1 month postpartum. After adjustment, natives exposed to free samples were more likely to never breastfeed or drop exclusive breastfeeding within 1 month after delivery (aOR = 1.90, 95%CI: 1.06-3.42), while those exposed to shop/pharmacy advertisement were less likely to (aOR = 0.62, 95%CI 0.43-0.89). Conversely, migrants exposed to newspaper/magazine advertisement were less likely to never breastfeed or drop exclusive breastfeeding within 1 month postpartum (aOR = 0.54, 95%CI 0.31-0.95). Conclusions/Recommendations: Our results revealed differences in the effect of market factors on breastfeeding practices between native and migrant women, which might be explained by cultural factors. Future research should investigate the mechanisms underlying the direction of association between specific market factors and early breastfeeding practices.
- Marketing of breastmilk substitutes and early breastfeeding practices among native and migrant womenPublication . Lisi, Cosima; Teixeira, Cristina; Al Hamwi, Sousan; Rodrigues, Carina; Lopes, Sofia; Barros, HenriqueThere is a large body of evidence regarding the benefits of breastfeeding for mothers and their children. However, the influence of marketing of breastmilk substitutes on breastfeeding practices remains a big concern. The aim of this study is to examine the association between exposure to different breastmilk substitutes market factors and never breastfeeding or dropping exclusive breastfeeding within 1 month postpartum, comparing migrant with native women. Methods: This study is part of the project baMBINO, an ongoing research on perinatal health among migrant and native women in Portugal. Women with a live-birth and aged ≥ 18 years were recruited in 32 Portuguese public hospitals during admission for delivery. Data on breastfeeding practices and exposure to market factors were collected by telephone interviews at 1-3 months postpartum. According to their feeding practices within 1 month after delivery, women were classified into two categories: those who have never breastfed or have dropped exclusive breastfeeding, and those who have maintained exclusive breastfeeding. Five market factors were assessed: free samples, discounts, television, newspaper/magazine, and shop/ pharmacy advertisement. Logistic regression models were used to study the association between each market factor and early breastfeeding practices, adjusting for maternal age, education, parity, mode of delivery, and skin-to-skin contact in the first hour after birth. All analyses were stratified by women’s country of birth (native vs. migrant). Adjusted odds-ratio (aOR) and a respective 95% confidence interval (95%CI) were obtained. Results: Out of 539 natives and an equal number of migrant women, 43.4% and 36.7%, respectively, have either never breastfed or dropped exclusive breastfeeding within 1 month postpartum. After adjustment, natives exposed to free samples were more likely to never breastfeed or drop exclusive breastfeeding within 1 month after delivery (aOR = 1.90, 95%CI: 1.06-3.42), while those exposed to shop/pharmacy advertisement were less likely to (aOR = 0.62, 95%CI 0.43-0.89). Conversely, migrants exposed to newspaper/magazine advertisement were less likely to never breastfeed or drop exclusive breastfeeding within 1 month postpartum (aOR = 0.54, 95%CI 0.31-0.95). Conclusions/Recommendations: Our results revealed differences in the effect of market factors on breastfeeding practices between native and migrant women, which might be explained by cultural factors. Future research should investigate the mechanisms underlying the direction of association between specific market factors and early breastfeeding practices.
- Tobacco use during pregnancy among native and migrant women in Portugal: results from bambino studyPublication . Teixeira, Cristina; Al Hamwi, Sousan; Carrapatoso, Mariana; Cancela, Marilyne; Lisi, Cosima; Lopes, Sofia; Barros, HenriqueTobacco use is a major modifiable risk factor of adverse maternal and fetal health outcomes. Being a migrant has been associated with lower risk of smoking during pregnancy. However, it remains a matter of debate whether such association could be explained by other socio-demographic characteristics or whether such effect remains or increases according to the length of stay in the host country. This study examined the differences in maternal smoking prevalence between native, long-term and recent migrant women in Portugal. METHODS: This study was derived from baMBINO, a national project grounded on 32 public maternity units in mainland Portugal aiming to investigate the differences in perinatal healthcare and outcomes among migrant and native women. Recruitment took place during admission for delivery, inviting both native and foreign-born women. Participants included in this analysis (n=1107) were classified according to their country of birth and length of stay in Portugal into: native (Portuguese-born), recent migrant (foreign-born women who spent 10 years or less in Portugal), and long-term migrants (foreign-born women who spent more than 10 years in Portugal). Logistic regression model was fitted to estimate the association between the aforementioned migration statuses and having or not smoked tobacco during pregnancy, taking into account women’s age, parity, marital status, level of education, family income, country of origin of women’s parents and gestational age at the first prenatal care visit. Adjusted odds-ratio (OR) and respective 95% confidence interval (95%CI) were obtained. RESULTS: A little over half of the study participants were foreign-born and almost 60% of those were recent migrants. Tobacco smoking during pregnancy was evidently more prevalent among native women than among long-term or recent migrant women (14% vs. 8% and 4% respectively; p<0.001). Compared to native women, both long-term and recent migrant women were more likely to be unmarried, have a family income lower than 1000€, and have their first prenatal visit after 12 weeks of gestation. Long-term migrants were more likely to have Portuguese-born parents than recent migrants (26.0% vs. 2.5%; p<0.001). According to the multivariate regression model, having a higher educational level was significantly associated with not smoking during pregnancy (secondary school: OR=0.38; 95%CI:0.23–0.62; postgraduate education: OR=0.18; 95%CI:0.09–0.35), opposed to women who have 9 or less years of education. However no association was observed between smoking during pregnancy and maternal age (OR=1.10; 95%CI:0.60–2.01 and OR=0.95; 95%CI:0.57–1.58 for women aged less than 25 and 35 or more years, respectively, in comparison with women aged 25-34 years), family income (OR=1.30; 95%CI:0.77–2.18 for women with higher income), parity (OR=0.68; 95%CI:0.43–1.09 for multiparous in comparison with primiparous women), gestational age at first prenatal visit (OR=1.12, 95%CI:0.59–2.11 for women having their first prenatal visit after 12 weeks), having a foreign-born parent (yes vs no: OR=0.83; 95%CI:0.43–1.63) and marital status (single vs married women: OR=0.76; 95%CI:0.46–1.24). Smoking during pregnancy was significantly less frequent in recent and long-term migrants (OR=0.24; 95%CI:0.10-0.57, OR=0.52, 95%CI: 0.25-1.09 respectively) compared with native Portuguese women. CONCLUSION: Results of this study demonstrated significant disparities in the prevalence of maternal smoking during pregnancy according to the women’s place of birth and duration of stay in Portugal. Native-born women had a higher risk of smoking during pregnancy than foreign-born women. The increase in the duration of stay in the host country seemed to have a negative effect on maternal smoking of migrants in Portugal. Smoking cessation health strategies in pregnant women in Portugal need to be improved by taking into account the mentioned variations in smoking behaviors.
- Obstetric interventions among native and migrant women: a survey of episiotomy in PortugalPublication . Lorthe, Elsa; Teixeira, Cristina; Rodrigues, Teresa; Barros, HenriqueIt is unclear whether migrant women experience worse pregnancy outcomes than native women. A better comprehension of obstetric care provision, including controversial interventions such as episiotomy, is important to improve equity of service provision, overall maternal and neonatal health and to support evidence-informed perinatal health policy-making. We aimed to determine if migrant and native women giving birth vaginally have different risks of episiotomy and if the risk differs by migrant sub-groups. Methods: This study is based on a cross-sectional survey of foreign-born women with a random sample of native women, implemented in 32 public maternity units in mainland Portugal. We included 3583 women with vaginal delivery. Migrant status was defined by the woman’s country of birth (migrants, born abroad, vs natives, born in Portugal), then as subgroups of migrants from Brasil, Portuguese-speaking African countries (PSAC) and non Portuguese-speaking countries vs natives. The association between migrant status and episiotomy was assessed using multilevel logistic regression models, stratified by delivery mode, and adjusted for main risk factors of episiotomy. Results: The overall frequencies of episiotomy were 52.6% and 48.2% among the 1707 natives and the 1876 migrants, respectively (p = 0.01). With spontaneous delivery, migrant women had decreased odds of having an episiotomy (adjusted OR 0.70 [95% CI 0.58-0.83]), especially those from PSAC (aOR 0.57 [0.46-0.71]). However, with instrumental delivery, migrant women had increased odds of episiotomy (aOR 2.47 [95% CI 1.50-4.07]), especially those from Brasil (aOR 3.24 [1.18-8.92]) and non Portuguese-speaking countries (aOR 3.75 [1.827.71]). Conclusions: These results suggest non-medically justified differential care during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use, in a country with a high frequency of medical intervention during delivery. Key messages: Portugal displays a high frequency of medical interventions during delivery, including episiotomy, highlighting the need for developing evidence-based recommendations. Migrant and native women have different risks of episiotomy, suggesting non-medically justified differential care