Intended for healthcare professionals

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Bucking the inequality gradient through early child development

BMJ 2010; 340 doi: (Published 11 February 2010) Cite this as: BMJ 2010;340:c468

Rapid Response:

It’s time for a new healthcare policy in Italy to improve prognosis of newborns of immigrant parents.

Hertzman and collegues argue that a good start in life is the key to
reducing health and social inequalities and that governments should invest
more in programmes to support early child development (1). Besides this
desirable plan, even in some developed countries such as Italy,
interventions are needed also before birth to reduce neonatal mortality
and morbidity. This would facilitate prenatal care especially for pregnant
immigrant women who, more frequently than Italians, face poor social,
economic and cultural conditions (higher rate of minor and/or unwed
mothers, low family income, heavier and irregular employment, unsuitable
dietary habits, poor living and hygienic conditions, late or inadequate
obstetrical and gynaecological care). In Italy there is a rising number
of children born to citizens coming from abroad. According to ISTAT, the
national statistics bureau, in 2008 there were 72472 children born to
immigrant women, equal to 12.6% of all Italian births (2).

As the
Policlinico Umberto I in Rome is a referral centre for high risk
pregnancies, a research study was carried on the 16821 children born in
the last 10 years (2000-2009) at this hospital. As many as 22.5% were
born to immigrant mothers; compared to children born to Italians, these
newborns had higher rate of 1) delivery before 37 weeks’ gestation (15.9
vs 14%; OR: 1.12; IC 95%: 1.01-1.24), 2) incidence of birth weight below
1000 g (1.6% vs 1.2%; OR: 1.37; IC 95% :1.01-1.84), 3) gestational age
below 28 weeks (1.7 % vs 1.0 %; OR:1.70; IC 95%: 1.25-2.31) and 4) a
series of pathological conditions (birth trauma, newborn depression,
metabolic disorders, Rh alloimmunisation, and malformations) requiring
more often NICU stays (7.1 vs 5.8%; OR:1.20; IC 95%: 1.04-1.39). Newborns
to foreigners also had higher hospital mortality rate than those born to
Italians (0.7 vs 0.4 %; OR=1.83; IC 95% 1.13-2.99). The worst prognosis
was related to the more severe conditions of newborns of foreigners; in
fact, when the data were corrected for variables such as gestational age
or birth weight, the differences in mortality rates completely levelled
out. This implies that children born to foreigners received the same
medical care as those born to Italians, but had more often lower birth
weight and, being more often premature, experienced higher complications

Although the immigrant women in our population sample were on average
younger than Italians (28.9 vs 32.4 yrs; p<_0.001 more="more" often="often" they="they" gave="gave" birth="birth" to="to" high="high" risk="risk" newborns.="newborns." p="p"/>Improved mother and child health among immigrants can be achieved in Italy
by facilitating access to health services and prenatal care for pregnant
immigrant women, and by reconsidering the crime of illegal immigration
recently introduced by the Security Act of the current Italian government,
which has led many irregular immigrants to avoid hospitals out of fear of
being reported to the police and consequently expelled. According to
Italian legislation, all pregnant women—whatever their legal status—are
entitled to free access to all medical services and to a six-moth
residency permit after delivery. This regulation has now lost its value
because women fear that once their permit has expired they can be
identified and expelled. This could translate into a much lower number
of examinations during gestation and, consequently, a higher risk of
perinatal mortality.

Mario De Curtis, Renato Lucchini

Dipartimento di Pediatria, Sapienza-Università di Roma


1)Hertzman C, Siddiqi A, Hertzman E, Irwin LG, Vaghri Z, Houweling
TA, Bell R, Tinajero A, Marmot M. Bucking the inequality gradient through
early child development. BMJ. 2010 Feb 9;340:c468. doi: 10.1136/bmj.c468.

accessed 2 April 2010

Competing interests:
None declared

Competing interests: No competing interests

04 April 2010
Mario De Curtis
Professor of Paediatrics
Renato Lucchini.
Department of Paediatrics, University of Rome La Sapienza