J Epidemiol Community Health 68:863-868 doi:10.1136/jech-2013-202917
  • Other topics

Too heavy, too late: investigating perinatal health outcomes in immigrants residing in Spain. A cross-sectional study (2009–2011)

  1. Bárbara A Revuelta-Eugercios1,3
  1. 1Centre for Economic Demography, Lund University, Lund, Sweden
  2. 2Institute for Futures Studies, Stockholm, Sweden
  3. 3Institut National d'Études Démographiques, Paris, France
  1. Correspondence to Dr S Juárez, Centre for Economic Demography, Lund University, Box 7083, Lund SE-22007, Sweden; sol.juarez{at}
  • Received 31 May 2013
  • Revised 1 April 2014
  • Accepted 7 April 2014
  • Published Online First 28 April 2014


Background Studies have shown that immigrants residing in Spain have lower risks of delivering low birthweight (LBW) and preterm babies despite their socioeconomic disadvantages (the healthy migrant paradox). However, less is known about other important perinatal outcomes derived from birth weight and gestational age such as macrosomia and post-term birth. This paper aims to compare the main indicators related to birth weight and gestational age (LBW, macrosomia, preterm and post-term) for immigrants and Spaniards.

Methods Cross-sectional study based on the Spanish vital statistics for years 2009–2011. Multinomial regression models were performed to obtain crude and adjusted ORs and their 95% CIs.

Results After adjusting for known confounders, compared with Spaniards, most immigrant groups show lower or not significantly different risks of delivering LBW (OR between 0.65 and 0.87) or, more exceptionally, preterm babies (between 0.75 and 0.93). However, most of them also show higher risks of delivering macrosomic (OR between 1.21 and 2.58) and post-term babies (OR between 1.11 and 1.50). Mothers from sub-Saharan Africa show a higher risk in all perinatal outcomes studied.

Conclusions The immigrant health paradox should be carefully assessed in comprehensive terms. Together with a predominantly lower risk of LBW, most immigrants have a higher risk of macrosomia, post-term and preterm births. These results have policy-making implications since studying the right tail of the birth weight and gestational age distributions implies considering a different set of risk factors.