Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study

BACKGROUND: Migration is a risk factor for adverse neonatal outcomes. The various impacts of maternal origin have been reported previously. The aim of this study was to investigate associations between paternal origin and adverse neonatal outcomes in births to migrant and Norwegian-born women in Norway. METHODS AND FINDINGS: This nationwide population-based study included births to migrant (n = 240,759, mean age 29.6 years [±5.3 SD]) and Norwegian-born women (n = 1,232,327, mean age 29.0 years [±5.1 SD]) giving birth in Norway in 1990–2016. The main exposure was paternal origin (Norwegian-born, foreign-born, or unregistered). Neonatal outcomes were very preterm birth (22(+0)–31(+6) gestational weeks), moderately preterm birth (32(+0)–36(+6) gestational weeks), small for gestational age (SGA), low Apgar score (<7 at 5 minutes), and stillbirth. Associations were investigated in migrant and Norwegian-born women separately using multiple logistic regression and reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs), adjusted for year of birth, parity, maternal and paternal age, marital status, maternal education, and mother’s gross income. In births to migrant women, a foreign-born father was associated with increased odds of very preterm birth (1.1% versus 0.9%, aOR 1.20; CI 1.08–1.33, p = 0.001), SGA (13.4% versus 9.5%, aOR 1.48; CI 1.43–1.53, p < 0.001), low Apgar score (1.7% versus 1.5%, aOR 1.14; CI 1.05–1.23, p = 0.001), and stillbirth (0.5% versus 0.3%, aOR 1.26; CI 1.08–1.48, p = 0.004) compared with a Norwegian-born father. In Norwegian-born women, a foreign-born father was associated with increased odds of SGA (9.3% versus 8.1%, aOR 1.13; CI 1.09–1.16, p < 0.001) and decreased odds of moderately preterm birth (4.3% versus 4.4%, aOR 0.95; CI 0.91–0.99, p = 0.015) when compared with a Norwegian-born father. In migrant women, unregistered paternal origin was associated with increased odds of very preterm birth (2.2% versus 0.9%, aOR 2.29; CI 1.97–2.66, p < 0.001), moderately preterm birth (5.6% versus 4.7%, aOR 1.15; CI 1.06–1.25, p = 0.001), SGA (13.0% versus 9.5%, aOR 1.50; CI 1.42–1.58, p < 0.001), low Apgar score (3.4% versus 1.5%, aOR 2.23; CI 1.99–2.50, p < 0.001), and stillbirth (1.5% versus 0.3%, aOR 4.87; CI 3.98–5.96, p < 0.001) compared with a Norwegian-born father. In Norwegian-born women, unregistered paternal origin was associated with increased odds of very preterm birth (4.6% versus 1.0%, aOR 4.39; CI 4.05–4.76, p < 0.001), moderately preterm birth (7.8% versus 4.4%, aOR 1.62; CI 1.53–1.71, p < 0.001), SGA (11.4% versus 8.1%, aOR 1.30; CI 1.24–1.36, p < 0.001), low Apgar score (4.6% versus 1.3%, aOR 3.51; CI 3.26–3.78, p < 0.001), and stillbirth (3.2% versus 0.4%, aOR 9.00; CI 8.15–9.93, p < 0.001) compared with births with a Norwegian-born father. The main limitations of this study were the restricted access to paternal demographics and inability to account for all lifestyle factors. CONCLUSION: We found that a foreign-born father was associated with adverse neonatal outcomes among births to migrant women, but to a lesser degree among births to nonmigrant women, when compared with a Norwegian-born father. Unregistered paternal origin was associated with higher odds of adverse neonatal outcomes in births to both migrant and nonmigrant women when compared with Norwegian-born fathers. Increased attention to paternal origin may help identify women in maternity care at risk for adverse neonatal outcomes.