PUBLI : Maxime Eslier, Catherine Deneux-Tharaux, Priscille Sauvegrain, Thomas Schmitz, Dominique Luton, Laurent Mandelbrot, Candice Estellat et Elie Azria, « Severe maternal morbidity among undocumented migrant women in the PreCARE prospective cohort study », BJOG, 2022, online


In Europe, migrant women, espe­cially from sub-Saharan Africa, have higher risks of adverse maternal outcomes than non-migrants. Legal status, a component of migrant condi­tion, may be an impor­tant, and poten­tially actio­nable, risk factor. We aimed to assess the risk of severe maternal outcomes among migrant women, consi­de­ring both their legal status and birthplace.

Pros­pec­tive cohort study.

Four mater­nity units around Paris in 2010–2012.

9599 women with singleton pregnancies.

Legal status was cate­go­rized in four groups : refe­rence group of non-migrant native French­women, legal migrants with French or Euro­pean citi­zen­ship, other legal migrants with non-Euro­pean citi­zen­ship, and undo­cu­mented migrants. The risk of severe maternal morbi­dity was assessed with multi­va­riable logistic regres­sion models accor­ding to women’s legal status and birthplace.

Main Outcome Measure
Binary compo­site crite­rion of severe maternal morbidity.

Undo­cu­mented migrants had resided less time in France, expe­rienced social isola­tion, linguistic barriers and poor housing condi­tions more frequently, and had a prepre­gnancy medical history at lower risk than other migrants. The multi­va­riable analysis showed they had a higher risk of severe maternal morbi­dity than non-migrants (33/​715 (4.6%) versus 129/​4523 (2.9%), adjusted odds ratio [aOR] 1.68 ; 95% confi­dence interval [CI] 1.12–2.53). This increased risk was signi­fi­cant for undo­cu­mented women from sub-Saharan Africa (18/​308 (5.8%) versus 129/​4523 (2.9%), aOR 2.26 ; 95%CI 1.30–3.91), and not for those born elsew­here (15/​407 (3.7%) versus 129/​4523 (2.9%), aOR 1.44 ; 95%CI 0.82–2.53).

Undo­cu­mented migrants are the migrant subgroup at highest risk of severe maternal morbi­dity, while the preva­lence of risk factors does not appear to be higher in this subgroup. This finding suggests that their inter­ac­tion with mater­nity care services may be non-optimal.

Refe­rence page