Delayed Antenatal Care, Infant Outcomes, and Healthcare Use by Maternal Migration Status: A Population-Based Cohort Study — The Association Specialists
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  3. Delayed Antenatal Care, Infant Outcomes, and Healthcare Use by Maternal Migration Status: A Population-Based Cohort Study

Delayed Antenatal Care, Infant Outcomes, and Healthcare Use by Maternal Migration Status: A Population-Based Cohort Study (23865)

Sadia Hossain 1 , Sithum Munasinghe 1 , Ju-Lee Oei 2 , Marrwah Ahmadzai 1 , Andrew Page 1
  1. Discipline of Public Health, School of Medicine, Faculty of Health, Western Sydney University, Western Sydney University, Campbelltown, NSW, Australia
  2. Faculty of Health, Western Sydney University, Western Sydney University, Prestons, NSW, Australia

Background

Timely antenatal care (ANC) is critical for improving infant outcomes, yet disparities by maternal migration status persist. This study investigated how ANC timing relates to infant outcomes and healthcare utilisation across different migration groups in Australia.

Methods

A retrospective cohort study was conducted using births to non-Indigenous mothers in New South Wales (2002–2020; n=1,720,033). Mothers were categorised as Australia-born, English-speaking migrant mother (ESM), or migrant mother from a non-English-speaking country (non-ESM). ANC timing was defined as early (<=12 weeks) or late (>12 weeks). Outcomes included NICU admission, Apgar score <7, 1-year mortality, or out-of-home care by 1-year (OOHC). Adjusted risk ratios (RR) and 95% confidence intervals (CI) were estimated using Poisson regression, with Australia-born mothers receiving early ANC as the reference.

Results

Compared to Australia-born mothers with early ANC (reference), Australia-born mothers with late ANC had higher risks of mortality (RR=1.24, 95%CI 1.15–1.32), NICU admission (RR=1.07, 1.05–1.08), low Apgar (RR=1.17, 1.14–1.20), and OOHC (RR=2.38, 2.24–2.54). Conversely, ESM mothers with early ANC showed similar mortality risk to the reference but lower OOHC (RR=0.65, 0.50–0.84) and rehospitalisation. Late ANC for ESM mothers increased risks for low Apgar (RR=1.20, 1.13–1.28) and OOHC (RR=1.60, 1.34–1.92). 

In contrast, non-ESM mothers faced 29% higher mortality (RR=1.29, 1.19–1.40) even with early ANC, alongside lower risks for OOHC (RR=0.41, 0.34–0.50) and lower rehospitalisation (RR=0.81, 0.80–0.81). Late ANC among non-ESM mothers showed similarly elevated risks for mortality (RR=1.27, 1.16–1.39) and lower rehospitalisation (RR=0.77, 95%CI 0.76–0.78).

Conclusion

While early ANC is associated with improved outcomes for Australia-born and ESM mothers, persistent disparities for non-ESM mothers regardless of ANC timing suggest that clinical access alone is insufficient. Addressing these inequities requires culturally responsive care models that tackle broader structural determinants of migrant health.