Public health, policy, and clinical interventions to improve perinatal care for migrant women and infants in high-income countries: a systematic review

Kerrie Stevenson; Samuel Edwards; Kemi Ogunlana; Maha Alomari; Rukayat Agoropopoola; William Henderson; Nuria Sanchez Clemente; Hannah Rayment-Jones; Majel McGranahan; Maria Marti Castaner; Serena Luchenski; Gracia Fellmeth; Fiona Stevenson; Marian Knight; Robert Aldridge

doi:10.1016/j.eclinm.2024.102938

Public health, policy, and clinical interventions to improve perinatal care for migrant women and infants in high-income countries: a systematic review

EClinicalMedicine. 2024 Nov 19:78:102938. doi: 10.1016/j.eclinm.2024.102938. eCollection 2024 Dec.

Authors

Kerrie Stevenson¹, Samuel Edwards², Kemi Ogunlana¹, Maha Alomari¹, Rukayat Agoropopoola¹, William Henderson³, Nuria Sanchez Clemente^{4

5}, Hannah Rayment-Jones⁶, Majel McGranahan², Maria Marti Castaner⁷, Serena Luchenski⁸, Gracia Fellmeth⁹, Fiona Stevenson¹⁰, Marian Knight⁹, Robert Aldridge^{11

12}

Affiliations

¹ Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK.
² Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK.
³ Library Services, University College London, London, WC1E 6BT, UK.
⁴ Centre for Neonatal and Paediatric Infection, St. George's University, London, SW17 0RE, UK.
⁵ Health Equity Action Lab, Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
⁶ Department of Women and Children's Health, King's College London, Strand, London, WC2R 2LS, UK.
⁷ Danish Research Centre for Migration, Ethnicity, and Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 København K, Denmark.
⁸ Collaborative Centre for Inclusion Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
⁹ National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
¹⁰ Research Department of Primary Care and Health, Royal Free Campus, Rowland Hill Street, London, NW33 2PF, UK.
¹¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA.
¹² Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.

Abstract

Background: Migrant women who are pregnant or postpartum and their infants are often at increased risk of poorer perinatal outcomes compared to host country populations. This review aimed to identify public health, policy, and clinical interventions to improve maternity care for migrant women and their infants in high-income countries (HICs).

Methods: In this systematic review we searched EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, Web of Science, and grey literature from inception to 13th March 2024, with no language or date restrictions (PROSPERO: CRD42022380678). Interventional and observational studies assessing the effectiveness of any intervention to improve perinatal care for migrant women and their infants in HICs delivered in the pregnancy, peripartum, or postpartum period (up to one year after birth) were included. Quantitative outcomes were extracted. Qualitative studies were excluded. The main outcomes of interest were preterm birth, birthweight, and appointment attendance. Quantitative synthesis was conducted using Harvest plots and binomial exact calculations.

Findings: 15,689 records were retrieved, 29 studies comprising data from 16,763,837 women were included. 22 studies (75.9%) included multiple interventions. Five interventions had strong evidence of effectiveness. Two clinical interventions: 100.0% of studies including specialist multidisciplinary teams improved one or more of the main outcomes of interest, namely preterm birth, birthweight, and appointment attendance (95% confidence interval 73.5-100.0%; p < 0.001); and 90.9% of studies including specialist in-person interpreting improved one or more of the main outcomes of interest (58.7-100.0%; p = 0.012). Three public health or policy interventions: 100.0% of social welfare interventions (75.3%-100.0%; p < 0.001) improved one or more of the main outcomes of interest; 100.0% of maternal education interventions (71.5-100.0%. p < 0.001), and 83.3% of studies assessing access to free healthcare (51.6-97.9%; p = 0.039).

Interpretation: The findings suggest that multicomponent interventions comprising multidisciplinary teams, in-person interpreting, maternal education, and social welfare support can improve perinatal outcomes for migrant women and their infants. Removing financial barriers to care may improve perinatal outcomes and be cost saving to healthcare systems. However, these findings should be interpreted with caution given that most included studies were of poor quality and that sensitivity analysis restricting to interventional studies only did not demonstrate any effect on the main outcomes of interest.

Funding: KS is supported by a National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR302577). HRJ is supported by an NIHR Advanced Fellowship (NIHR303183). HRJ is supported by NIHR Applied Research Collaboration (ARC) South London. MM is supported by a Medical Research Council Clinical Research Training Fellowship (Grant number MR/W01498X/1). GF is supported by a Nuffield Department of Population Health Clinical Research Fellowship. MK is an NIHR Senior Investigator (NIHR303806). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Keywords: Health policy; Obstetrics; Paediatrics; Public health.