Do Antenatal Interventions Improve Maternal and Perinatal Outcomes for Migrant Women Living in High-Income Countries and What Guidelines Exist for Migrant Women? A Systematic Review and Meta-Analysis.

Abstract

Background: Given the rise in migrant women giving birth in high-income countries (HICs) there is a need to identify and evaluate the efficacy of existing interventions that address disparities in adverse pregnancy outcomes experienced by migrant women.

Objective: This review aims to identify any antenatal interventions offered to migrant women living in HICs, evaluate their efficacy at improving perinatal and maternal adverse outcomes, and to identify and evaluate pregnancy management guidelines relating to migrant status or ethnicity-specific practices or recommendations.

Search strategy: Medline, Embase, CINAHL, Scopus, TRIP, ProQuest, and the International Guidelines Library were searched from January 2010 to March 2023.

Selection criteria: English-language randomized controlled trials, mixed-methods, and observational studies reporting perinatal and maternal outcomes in women living in HICs receiving a migrant-specific antenatal intervention. An additional search of any pregnancy management guidelines relating to migrant status or ethnicity-specific practices or recommendations was completed.

Data collection and analysis: Two authors independently conducted data extraction. Outcomes of interest included perinatal (stillbirth, neonatal death, 5-min post-delivery Apgar score < 7, NICU admission, small for gestational age, large for gestational age, low birth weight, and preterm birth) and maternal outcomes (mortality, gestational diabetes, gestational hypertension, pre-eclampsia, caesarean birth, instrumental birth, and induction of labour). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated and pooled for meta-analysis using a random-effects model. All studies and guidelines were assessed using relevant risk assessment tools.

Main results: Six studies met the inclusion criteria for this review. Meta-analysis showed that infants born to women offered a migrant-specific antenatal intervention had lower odds of stillbirth (OR 0.60 95% CI 0.37-0.97, p = 0.04, I² = 0%) when compared to those in the standard care group. However, the use of migrant-specific interventions increased the odds of labor induction (OR 1.38 95% CI 1.27-1.49, p = < 0.01, I² = 0%). Additionally, we identified 18 guidelines; however, no migrant or ethnicity-specific recommendations were supported by high-level evidence.

Conclusion: Several migrant-specific antenatal interventions exist for migrant women living in HICs. These include fetal monitoring, group antenatal care programs, and a cultural training program for midwives. Despite heterogeneity between interventions, together they reduced the odds of stillbirth. Of the pregnancy management guidelines identified, most recommendations were largely based on findings from systematic reviews of observational and cohort studies, highlighting the lack of higher-quality evidence from clinical trials currently available.