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Am J Perinatol 2022; 39(08): 883-888
DOI: 10.1055/s-0040-1719117
Original Article

Birth Tourism Is Associated with Fewer Neonatal Intensive Care Unit Admissions: A Healthy Migrant Effect?

Authors

  • Jina Lim

    1   Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, California
    2   Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California

  • Wang-Dar Sun

    1   Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, California
    2   Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California

  • Lishi Zhang

    3   Biostatistics, Epidemiology, and Research Design Unit, Institute for Clinical and Translational Science, University of California Irvine, Irvine, California

  • Michel Mikhael 

    1   Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, California
    2   Division of Neonatology, Pomona Valley Hospital Medical Center, Pomona, California

Funding This work was partially supported by grant UL1 TR001414 from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through the Biostatistics, Epidemiology and Research Design Unit. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Abstract

Objective This work aimed to study perinatal, maternal, and neonatal characteristics of birth tourism (BT) mother–baby dyads and the rate of neonatal intensive care unit (NICU) admissions of BT infants.

Study Design Retrospective study at a regional perinatal center comparing BT mother–baby dyads to all dyads. BT infants admitted to the NICU were compared with a randomly selected group of infants admitted to the NICU during the same time period.

Results A total of 1,755 BT dyads were identified over 4 years. BT mothers were older (32 vs. 28 years, p < 0.0001), more likely to carry multiples (5.5 vs. 1.4%, p < 0.0001), deliver via cesarean section (40 vs. 34%, p < 0.0001), and require postpartum intensive care (0.6 vs. 0.1%, p < 0.0001). BT infants had significantly fewer NICU admissions 96 (5.5%) versus 3,213 (11.3%; p < 0.0001). There were no statistically significant differences in NICU course and outcome between BT and non-BT control infants.

Conclusion Birth tourism is associated with unique determinants of health. In our study, there were fewer NICU admissions, potentially explained by the healthy migrant effect.

Key Points

  • Birthright citizenship attracts foreigners to give birth in the United States.

  • BT is associated with unique social determinants of health.

  • Fewer NICU admissions in our study are possibly explained by the healthy migrant effect.

Keywords

birth tourism - healthy migrant hypothesis - neonate - neonatal intensive care unit

Authors' Contributions

J.L. contributed to the conceptualization and design of the study, the collection, analysis, and interpretation of the data. She drafted the initial manuscript and approved the final manuscript as submitted. W.D.S. contributed to the conceptualization and design of the study and the collection and interpretation of the data. He contributed to all drafts of the manuscript and approved the final manuscript as submitted. L.Z. contributed to the analysis and interpretation of the data. She contributed to all drafts of the manuscript and approved the final manuscript as submitted. M.M. contributed to the conceptualization and design of the study and the collection and interpretation of the data. He contributed to all drafts of the manuscript and approved the final manuscript as submitted.




Publication History

Received: 23 July 2020

Accepted: 25 September 2020

Article published online:
09 November 2020

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