ORIGINAL ARTICLE Country of origin, social support and the risk of small for gestational age birth Elisabeth Dejin-Karlsson 1 and Per-Olof O ¨ stergren 2 1 School of Health and Society, Malmo ¨ University, 2 Department of Community Medicine, Lund University, Sweden Scand J Public Health 2004; 32: 442–449 Aims: This study investigates the risk of small for gestational age (SGA) in relation to country of origin of the mother. The role of psychosocial resources, socioeconomic and lifestyle factors was examined in different causal models. Methods: Among all pregnant nulliparous women in the city of Malmo ¨ , Sweden, who gave birth in 1991 – 92, 872 (87.7%) women completed a questionnaire during their first antenatal visit. The study was carried out among women whose pregnancies resulted in a singleton live birth (n~826); 22% (n~182) of these women were foreign-born. Results: Fifty-five (6.7%) of the infants were classified as SGA, 37 (5.7%) of mothers of Swedish origin and 18 (9.7%) of foreign origin. SGA deliveries were much more prevalent among Middle East- and North Africa-born women (22%) and sub-Saharan-born women (15%). In all, women of foreign origin had increased odds for delivering SGA babies (OR~1.8, 95% CI~1.0,3.2). In a multivariate analysis psychosocial and socioeconomic factors explained 30% and 40%, respectively, of the increased SGA risk. Psychosocial factors seemed to be more prominent risk factors for SGA among mothers of foreign origin. A possible synergistic relation was demonstrated between foreign origin of the mother and low social anchorage. Conclusions: This study showed that psychosocial factors, most probably linked to a disadvantaged social situation, could be the theoretically most important focus for preventing SGA in immigrant women. This could also further support a hypothesis of a link between psychosocial stress and SGA in general. However, this should not exclude the need for intervention in the antenatal care system in terms of specially tailored support and education. Key words: country of origin, lifestyle factors, psychosocial resources, small for gestational age, socioeconomic factors. Elisabeth Dejin-Karlsson, Department of Nursing, School of Health and Society, Malmo ¨ University, SE-205 06 Malmo ¨, Sweden. E-mail: elisabeth.dejin-karlsson@hs.mah.se INTRODUCTION A number of studies have investigated country of origin and psychosocial factors as risk factors for antenatal complications (1 – 3). Adequate psychosocial resources, such as social network and social support, have been shown to be of importance for a person in order to cope with different potentially stressful situations in daily life (4 – 6). Pregnancy is a period in life when most women experience physical as well as psychological, social, and relational changes. Psycho- social stress and its effect on pregnancy outcome have therefore received increased attention over the last decade (7). The ability of social support to predict birth weight was found to be as strong as that of traditional risk factors such as obstetric risk (8). Psychosocial stress is likely to be even greater for pregnant women of foreign origin since in addition they have to adapt to a new country with a different culture. Also, disparities in pregnancy outcome according to ethnic origin are often closely paralleled by disparities according to socioeconomic factors (9). A 10-year specification from the Swedish Medical Birth Register showed that women from Denmark and sub-Saharan Africa had an increased risk of delivering low birth weight (LBW) and small for gestational age (SGA) children (10). Recently, a six-year follow-up study from Malmo ¨ pointed out that women of foreign origin, especially from sub-Saharan Africa, have a higher risk of SGA deliveries and perinatal mortality than a compar- able group of Swedish women (11). The Swedish studies consisted of data from local and national registers but lacked information about psychosocial and socio- economic variables. These factors, however, can be of importance to explain differences in perinatal outcomes between women. We have previously reported that psychosocial factors seem to influence intrauterine growth and increase the risk of giving birth to SGA infants (12). The specific aim of this study was to investigate # Taylor & Francis 2004. ISSN 1403-4948 DOI: 10.1080/14034940410028172 Scand J Public Health 32