Immigration and C-sections incidence: Maternal care and perinatal outcomes in the context of the pandemic in Chile.

Introduction: Immigration has increased significantly in Chile. Despite that all pregnant women, regardless of nationality and immigration status, have the right to access to all healthcare services during pregnancy, childbirth, and postpartum, inequities in health care outcomes and health provision have been reported. During COVID-19 pandemic, these inequities are completely unknown. Objective: The aim of this study was to compare the incidence of c-sections according to mother's migration status, as well as other maternal care and perinatal outcomes in women giving birth at San José Hospital in Santiago, Chile, during the COVID-19 pandemic. Methods: A retrospective cohort study was designed including 10,166 registered single births at the San José Hospital between March 2020 and August 2021. To compare between groups, statistical tests such as Chi-square and Fisher's exact were used. Log Binomial regression models were performed adjusted for potential confounding variables. To estimate the strength of association the relative risk was used. Results: Immigrant mothers account for 48.1% of the registered births. Compared to non-immigrant women, immigrants exhibit a higher proportion of c-section, specifically, emergency c-section (28.64% vs. 21.10%; p-value < 0.001) but a lower proportion of and having a preterm birth (8.24% vs. 13.45%; p < 0.05), receiving personalized childbirth care (13.02% vs. 14.60%; p-value < 0.05), companion during labor and childbirth (77.1% vs. 86.95%; p-value < 0.001), And postpartum attachment to newborn (73% vs. 79.50%; p-value < 0.001). The proportion of COVID exposure was not significant between groups, not the severity also. Haitians had a highest risk of undergoing emergency c-section (aRR = 1.61) and Venezuelans had a highest risk of elective c-section (aRR = 2.18) compared to non-immigrants. Conclusion: This study reports high rates of c-sections in the entire population, but in immigrant populations it is even higher. Additionally, it found gaps in maternal care and perinatal outcomes between immigrants and non-immigrants. More studies are needed to elucidate the possible causes of these differences and establish new regulations to protect the reproductive rights of the immigrant population.

Salud materna y perinatal de gestantes haitianas residentes en Santiago de Chile: situación y desafíos / Maternal and perinatal health of pregnant Haitian women residing in Santiago de Chile: situation and challenges

Objetivo: Comparar variables sociodemográficas, nutricionales y obstétricas, así como indicadores maternos y perinatales entre gestantes chilenas y gestantes haitianas residentes en la Región Metropolitana de Santiago de Chile. Método: Estudio observacional analítico de prevalencia en un hospital de Santiago, aprobado por el Comité de Ética del Servicio Metropolitano Norte de Chile. Datos recolectados de historias clínicas con consentimiento informado. Se realizó un análisis comparativo entre chilenas y haitianas. Se utilizaron la prueba de chi-cuadrado para variables categóricas y el test de la t para variables cuantitativas. Para calcular la estimación del riesgo se realizaron modelos de regresión logística crudos y ajustados con sus respectivos IC al 95 % en el programa Stata 15.0. Resultados: Se consideró a la totalidad de gestantes chilenas (n= 1578) y haitianas (n= 261) con gestación única que tuvieron su parto y sus respectivos recién nacidos (n= 1839) entre enero y julio de 2017. Las chilenas tuvieron mayor probabilidad de insulinorresistencia (8,45 [2,59-27,56]) y obesidad que las haitianas (OR: 3,58 [2,42-5,29]). Las gestantes haitianas tuvieron mayor probabilidad de ingreso tardío a atención prenatal (OR: 3,33 [2,50-4,34]), bajo peso materno (OR: 3,44 [2,17-5,55]), VIH (OR: 12,5 [3,03-50,00]), anemia (OR: 5 [3,03-9,09]), cesáreas (OR: 1,51 [1,58-2,12]) y RN PEG (OR: 1,72 [1,12-2,63]). Conclusiones: La salud materna y perinatal de las gestantes haitianas presenta problemáticas de salud materna y nutricionales diferentes a las de las chilenas, y una mayor tasa de cesárea. Se requieren estudios para indagar en la causa de estas últimas, así como estrategias y capacitaciones que favorezcan la adhesión a la atención prenatal precoz de las gestantes haitianas. (AU)

Objective: To compare sociodemographic characteristics and maternal and perinatal outcomes between Chilean and Haitian pregnant women in the Metropolitan Region of Chile.Methodology: Observational analytical study of prevalence, approved by the Ethics Committee of the North Metropolitan Service of Chile, Data collected from medical records with informed consent. A comparative analysis between Chilean and Haitian women was carried out. A Chi-square test was used for categorical variables and t-test for quantitative variables. For risk estimation, crude and adjusted logistic regression models were performed with their respective 95 % CI in Stata 15.0 program.Results: Universe of 1,578 Chilean pregnant women and 261 Haitian pregnant women assisted in a Santiago hospital. Chilean women had a higher probability of insulin resistance 8.45 [2.59-27.56] and obesity than Haitian women (OR: 3.58 [2.42-5.29]). Haitian pregnant women were more likely to have a late admission to prenatal care (OR: 3.33 [2.50-4.34]), low maternal weight (OR: 3.44 [2.17-5.55]), HIV (OR: 12.5 [3.03-50.00]), anemia (OR: 5 [3.03-9.09]), caesarean sections (OR: 1.51 [1.58-2.12]) and RN PEG (OR: 1.72 [1.12-2.63]).Conclusions: The maternal and perinatal health of pregnant Haitians presents maternal and nutritional health problems different from the Chilean ones and a high rate of cesarean section. Studies are required to investigate the cause of the latter, as well as strategies and training that promote adherence to early prenatal care for Haitian pregnant women. (AU)

Womens access to health care: Gaps that the future health care reform in Chile must solve. / Acceso de la mujer a la atención de salud: brechas que la futura reforma de salud en Chile debe resolver.

INTRODUCTION: In the Chilean health system, difficulties complicate womens access to health care and aggravate the complexity of health-illness processes in their interaction as users or caregivers. OBJECTIVE: In the national and international literature, we aimed to identify gaps in womens access to health care derived from gender disparities and the exercise of gender roles in a prioritized set of health problems. These problems exacerbate gender gaps and should be considered in health reform. METHODS: We made a literature review through algorithms, snowball sampling, and reference lists from November 2020 to March 2021. The population included were women of all ages, including women users of the health system and women caregivers of specific pathologies. The search was conducted in parallel by four investigators divided into two groups. It was cross-validated to ensure inter-investigator reliability by standardizing evidence eligibility criteria. The analysis showed women users' and caregivers' dimensions for a set of pathologies prioritized by the extent of the disease burden. The pathologies analyzed included stroke, obesity, depression, musculoskeletal pain, and breast cancer. RESULTS: Among women users of the health system, problems of access, rates of use, experience, and outcome for the whole group of prioritized pathologies were observed. In the women caregiver dimension, we found that women are the primary health care providers. There is a knowledge gap concerning obesity and musculoskeletal conditions. However, both were reported as health consequences of womens caregiving roles.

INTRODUCCIÓN: En el sistema de salud chileno persisten dificultades que complejizan el acceso de mujeres de forma efectiva a las atenciones de salud, o bien, derivan en que experimenten procesos de salud-enfermedad más complejos en su interacción como usuarias o cuidadoras. OBJETIVO: Identificamos en la literatura nacional e internacional, brechas de acceso a la atención de salud en la mujer derivadas de disparidades de género y/o ejercicio del rol de género, en un conjunto priorizado de problemas de salud. Estos problemas contribuyen a la problematización de las brechas de género a ser consideradas en la reforma de salud. MÉTODOS: Hicimos una revisión de la literatura a través de algoritmos, muestreo en bola de nieve y listas de referencias, desde noviembre de 2020 hasta marzo de 2021. La población de análisis fueron mujeres de todas las edades usuarias de prestaciones de salud y cuidadoras en las mismas patologías abordadas. La búsqueda fue desarrollada en paralelo por cuatro investigadores, en dos grupos. Fue validada de forma cruzada asegurando la confiabilidad interevaluadores, estandarizando criterios de elegibilidad de la evidencia. El análisis se muestra en dimensiones de mujer usuaria y cuidadora, para un conjunto de patologías priorizadas por magnitud y carga de enfermedad: accidente vascular cerebral, obesidad, depresión, dolor musculoesquelético y cáncer de mama. RESULTADOS: En la dimensión de mujer usuaria, para todo el grupo de patologías priorizadas se observan problemas de acceso, tasas de uso, experiencia y resultados. Desde la dimensión de mujer cuidadora, la mujer ejerce principalmente los cuidados de salud. Existe un vacío en la literatura en relación con la obesidad y afecciones musculoesqueléticas. Sin embargo, ambas se reportaron como consecuencias de salud en su rol de cuidadora. CONCLUSIONES: El problema en la base, en ambas dimensiones, queda explicado por brechas de género biológicas, sociales y culturales que permean el ámbito de cuidados sanitarios. Proponer una nueva reforma de salud que solo se funde en la proposición de acceso a más prestaciones, es insuficiente de acuerdo con el contexto biopsicosocial de la mujer.

Pregestational obesity, maternal morbidity and risk of caesarean delivery in a country in an advanced stage of obstetric transition.

OBJECTIVE: To evaluate whether pregestational obesity is associated with the risk of caesarean section in pregnant women living in a country in an advanced stage of the obstetric transition. METHODS: Retrospective cohort study. Data were collected from prenatal and hospital records. Pregestational obesity was defined as: body mass index, [weight(k)/height (m2)] ≥30, and caesarean sections were categorized as elective, emergency, or non-emergency/medically necessary. Biodemographic and sociodemographic characteristics, obstetric and perinatal pathologies, and maternal anthropometric variables were assessed. Chi-square and t-tests were used to compare qualitative and quantitative variables, respectively. Simple and adjusted generalized linear models were used to evaluate the association between pregestational obesity and caesarean delivery. Finally, population attributable risk was calculated. Data analysis was performed using STATA.v.14.0. PARTICIPANTS: 2309 pregnant women with a singleton pregnancy who gave birth at a public hospital in the Metropolitan Region of Santiago, Chile in 2015. RESULTS: The prevalence of pregestational obesity was 21.4%, and the incidence of caesarean deliveries was 34.8% (33% of which corresponded to elective, 46% to emergency, and 21% to non-emergency/medically necessary caesarean deliveries). Pregestational obesity increased the risk of caesarean delivery (aRR = 1.46; 95%CI. [1.19-1.79] as well as the risk of elective (aRR = 1.74; 95%CI. [1.23-2.45]) and emergency caesarean delivery (aRR = 1.44; 95%CI. [1.03-2.00]). The population attributable risk of pregestational obesity for caesarean section was 32%. CONCLUSION: Given the significant association between pregestational obesity and caesarean delivery, it is necessary to develop strategies to decrease obesity among women of childbearing age in order to decrease obstetric intervention.

Resultados materno-perinatales de gestantes peruanas en Chile: Exploración del efecto del migrante sano / Maternal and perinatal outcomes of peruvian pregnant women in Chile: exploring the healthy immigrant effect

RESUMEN Objetivos: Comparar indicadores materno-perinatales entre gestantes chilenas y peruanas en Santiago de Chile entre enero y julio del 2017. Materiales y métodos: Estudio transversal analítico en 1578 chilenas y 318 peruanas atendidas en un hospital clínico de Santiago. Se realizó un análisis comparativo de las variables materno-perinatales por nacionalidad. Se realizaron modelos logísticos crudos y ajustados con sus intervalos de confianza al 95% (IC 95%). Resultados: Las gestantes peruanas residían en promedio 5,7 años en Chile, tenían más edad (28,1 ± 6,5 vs. 26,6 ± 6,5 años), menos desocupación (52,3% vs. 60,6%), más probabilidad de ingreso tardío al control prenatal (CP) (OR: 2,17, IC 95%: 1,69-2,78) y de tener anemia (OR: 3,45, IC 95%: 2,13-5,56) asociada al ingreso tardío a CP (OR ajustado: 0,43, IC95%: 0,33-0,56). Las gestantes chilenas tuvieron una mayor probabilidad de obesidad al ingreso al CP (OR: 2,48 IC 95%: 1,81-3,41) y al parto (OR: 2,03, 1,57-2,62). Así como, de diabetes gestacional (DG) (OR: 2,12, IC 95%: 1,24-3,61), parto prematuro (OR: 2,82, IC 95%: 1,59-5,01) e hijos con bajo peso al nacer (BPN) (OR: 3,10, IC 95%: 1,51-6,33). En el modelo ajustado la obesidad se asoció en forma independiente a la DG (OR ajustado: 3,8, IC 95%: 2,44-6,18) y al BPN (OR ajustado: 3,34, IC95%: 2,33-4,85. Conclusiones: El efecto del migrante sano se observa en gestantes inmigrantes peruanas, principalmente en resultados perinatales. Es necesario favorecer el ingreso precoz a la atención prenatal, prevenir la anemia y la obesidad, para evitar resultados materno-perinatales adversos en esta población.

ABSTRACT Objectives: To compare maternal and perinatal outcomes between Chilean and Peruvian pregnant women in Santiago, Chile, between January and July 2017. Materials and methods: Analytical cross-sectional study of 1,578 Chilean and 318 Peruvian women who attended a clinical hospital in Santiago. We conducted a comparative analysis of maternal and perinatal variables by nationality. Crude and adjusted logistic models were carried out with a 95% confidence interval (95% CI). Results: Peruvian pregnant women resided an average of 5.7 years in Chile, were older (28.1 ± 6.5 vs. 26.6 ± 6.5 years), had less unemployment (52.3% vs. 60.6%), were more likely to enter prenatal care (PC) late (OR: 2.17, 95% CI: 1.69-2.78) and had higher probability of having anemia (OR: 3.45, 95% CI: 2.13-5.56) associated with late entry to PC (adjusted OR: 0.43, 95% CI: 0.33-0.56). On the other hand, Chilean pregnant women were more likely to be obese upon entry to PC (OR: 2.48, 95% CI: 1.81-3.41) and at the time of delivery (OR: 2.03, 95% CI: 1.57-2.62). In addition, Chilean women had higher rates of gestational diabetes (GD) (OR: 2.12, 95% CI: 1.24-3.61), premature delivery (OR: 2.82, 95% CI: 1.59-5.01) and low birth weight (LBW) (OR: 3.10, 95% CI: 1.51-6.33). In the adjusted model, obesity was independently associated with GD (adjusted OR: 3.8, 95% CI: 2.44-6.18) and LBW (adjusted OR: 3.34, 95% CI: 2.33-4.85). Conclusions: The healthy immigrant effect was observed in pregnant Peruvian immigrants, mainly regarding the perinatal outcomes. It is necessary to promote early access to prenatal care and to stablish measures to prevent anemia and obesity, in order to avoid adverse maternal and perinatal outcomes in the studied population.

Maternal and perinatal outcomes of peruvian pregnant women in Chile: exploring the healthy immigrant effect. / Resultados materno-perinatales de gestantes peruanas en Chile: Exploración del efecto del migrante sano.

OBJECTIVES: To compare maternal and perinatal outcomes between Chilean and Peruvian pregnant women in Santiago, Chile, between January and July 2017. MATERIALS AND METHODS: Analytical cross-sectional study of 1,578 Chilean and 318 Peruvian women who attended a clinical hospital in Santiago. We conducted a comparative analysis of maternal and perinatal variables by nationality. Crude and adjusted logistic models were carried out with a 95% confidence interval (95% CI). RESULTS: Peruvian pregnant women resided an average of 5.7 years in Chile, were older (28.1 ± 6.5 vs. 26.6 ± 6.5 years), had less unemployment (52.3% vs. 60.6%), were more likely to enter prenatal care (PC) late (OR: 2.17, 95% CI: 1.69-2.78) and had higher probability of having anemia (OR: 3.45, 95% CI: 2.13-5.56) associated with late entry to PC (adjusted OR: 0.43, 95% CI: 0.33-0.56). On the other hand, Chilean pregnant women were more likely to be obese upon entry to PC (OR: 2.48, 95% CI: 1.81-3.41) and at the time of delivery (OR: 2.03, 95% CI: 1.57-2.62). In addition, Chilean women had higher rates of gestational diabetes (GD) (OR: 2.12, 95% CI: 1.24-3.61), premature delivery (OR: 2.82, 95% CI: 1.59-5.01) and low birth weight (LBW) (OR: 3.10, 95% CI: 1.51-6.33). In the adjusted model, obesity was independently associated with GD (adjusted OR: 3.8, 95% CI: 2.44-6.18) and LBW (adjusted OR: 3.34, 95% CI: 2.33-4.85). CONCLUSIONS: The healthy immigrant effect was observed in pregnant Peruvian immigrants, mainly regarding the perinatal outcomes. It is necessary to promote early access to prenatal care and to stablish measures to prevent anemia and obesity, in order to avoid adverse maternal and perinatal outcomes in the studied population.

OBJETIVOS: Comparar indicadores materno-perinatales entre gestantes chilenas y peruanas en Santiago de Chile entre enero y julio del 2017. MATERIALES Y MÉTODOS: Estudio transversal analítico en 1578 chilenas y 318 peruanas atendidas en un hospital clínico de Santiago. Se realizó un análisis comparativo de las variables materno-perinatales por nacionalidad. Se realizaron modelos logísticos crudos y ajustados con sus intervalos de confianza al 95% (IC 95%). RESULTADOS: Las gestantes peruanas residían en promedio 5,7 años en Chile, tenían más edad (28,1 ± 6,5 vs. 26,6 ± 6,5 años), menos desocupación (52,3% vs. 60,6%), más probabilidad de ingreso tardío al control prenatal (CP) (OR: 2,17, IC 95%: 1,69-2,78) y de tener anemia (OR: 3,45, IC 95%: 2,13-5,56) asociada al ingreso tardío a CP (OR ajustado: 0,43, IC95%: 0,33-0,56). Las gestantes chilenas tuvieron una mayor probabilidad de obesidad al ingreso al CP (OR: 2,48 IC 95%: 1,81-3,41) y al parto (OR: 2,03, 1,57-2,62). Así como, de diabetes gestacional (DG) (OR: 2,12, IC 95%: 1,24-3,61), parto prematuro (OR: 2,82, IC 95%: 1,59-5,01) e hijos con bajo peso al nacer (BPN) (OR: 3,10, IC 95%: 1,51-6,33). En el modelo ajustado la obesidad se asoció en forma independiente a la DG (OR ajustado: 3,8, IC 95%: 2,44-6,18) y al BPN (OR ajustado: 3,34, IC95%: 2,33-4,85. CONCLUSIONES: El efecto del migrante sano se observa en gestantes inmigrantes peruanas, principalmente en resultados perinatales. Es necesario favorecer el ingreso precoz a la atención prenatal, prevenir la anemia y la obesidad, para evitar resultados materno-perinatales adversos en esta población.