Obstetric outcomes in second-generation and migrant mothers: a cohort study in the Emilia-Romagna Region, Italy

PURPOSE: The second generation (people born in the host country to foreign parents) has grown significantly in Italy. While migration is known to impact maternal and neonatal health negatively, evidence on outcomes for second-generation mothers (SGMs) is limited. This study aimed to describe the socio-demographic characteristics and obstetric outcomes of SGMs, comparing them with first-generation and native mothers in an Italian region. METHODS: All deliveries in the Emilia-Romagna Birth Registry (2012-2023) were linked with the 15th Population Census (2011); this allowed the definition of migratory background. The outcomes included emergency and elective cesarean delivery, preterm birth, small for gestational age (SGA), and late antenatal care (ANC). Log-binomial models were used to estimate crude and adjusted prevalence ratios (aPR), also stratified by area of origin. RESULTS: 390,062 births were recorded; for 63%, it was possible to define the migratory background. Compared to native mothers, SGMs were younger and less educated; 79.5% held Italian citizenship. SGMs showed a lower risk of elective cesarean delivery (aPR 0.65, 95% CI 0.53-0.79) and higher risks of late ANC (aPR 1.91, 95% CI 1.69-2.15), emergency cesarean delivery (aPR 1.15, 95%CI 1.00-1.31), preterm birth (aPR 1.59, 95% CI 1.33-1.90), and SGA (aPR 1.15, 95% CI 0.99-1.33). Certain areas of origin, such as Sub-Saharan Africa, seemed to have an increased risk of negative outcomes. CONCLUSIONS: SGMs show worse social determinants and birth outcomes than natives. Currently, the second generation cannot be identified through administrative data; however, it merits greater attention, in terms of monitoring tools and health and social policies.