Risk factors of pregnancy morbidity in migrant women from Subsaharan Africa

Abstract Reduction of maternal mortality remains a major public health issue worldwide. In France, the latest national confidential enquiry regarding maternal mortality (2010-2012) stated a ratio of 10 /100 000 livebirths whereas the goal was 5/100 000. The risk of death among pregnant women from Subsaharan Africa (SSA) was 3 times higher. We performed a monocentric observational retrospective study from 01/01/2009 to 01/09/2016 in order to better understand the factors of maternal morbidity among SSA pregnant women. Demographic characteristics as well as pregnancy outcomes were collected. Antenatal clinics attendance was scored (+1 if positive, +1 if done following the recommended schedule). A total 1 489 (7%) out of 20 755 pregnancies were registred among SSA women. Mean age was 29 years (14-48), mean gestity/parity were respectively 3.5 and 1.8. About 38% of pregnancies occured in overweight or obese women. Obstetrical complications were seen in 542 (36%) pregnancies: gestational diabetes (n = 206, 36,4%), hypertensive disorders (n = 122, 8,2%), 19 had both. Pre-eclampsia represented 4%, sepsis 5%, premature rupture of membrane 5% and post partum haemorrhage 3%. Livebirths was high (97%) with a mean gestational age of 37(22-41), a mean birth weight of 3150g (500-5000). The unique maternal death in this cohort was due to amniotic fluid embolism. Complication risk factors were age (30 versus 28 years; p < 0.0001), BMI (26 versus 25 kg/m2; p < 0.0001), past history of chronic hypertension and pregestational diabetes (p < 0,001). Furthermore, the score of antenatal care attendance was low in those who presented pregnancy morbidities (p = 0.0006) (adjusted with age, BMI> 25 and chronic hypertension). Higher risk of maternal morbidity among SSA women is not only explained by individual risk factors but also by a lack of compliance to the recommended antenatal care even if they live in France. Further investigations including sociological studies are therefore needed. Key messages Maternal mortality and morbidity are higher among migrant women from Subsaharan Africa. Our study highlights a non compliance to the recommended antenatal care surveillance among risk factors.