Epidemiological assessment on birth outcomes among Marshallese migrants: a retrospective cohort study in the largest Marshallese community in the USA

Background: Marshallese migrants have experienced unique historical exposures related to nuclear testing, with potential implications for reproductive health. This study examined maternal and infant outcomes and birth defect prevalence among Marshallese individuals in Arkansas compared with Asian and other Pacific Islanders. Methods: A retrospective cohort study using Arkansas vital records and birth defects surveillance data (2001-2020) assessed prenatal care, birth outcomes and major congenital anomalies. Adjusted prevalence ratios (PRs) and 95% CI were estimated using Poisson regression. Results: Among 5427 Marshallese births, first-trimester prenatal care initiation was substantially lower (adjusted PR=0.21, 95% CI 0.19 to 0.23). Labour complications were higher among Marshallese mothers. Infants had higher risks of preterm birth (adjusted PR=2.15, 95% CI 1.80 to 2.57), low birth weight (adjusted PR=1.37, 95% CI 1.09 to 1.71), respiratory distress syndrome (adjusted PR=13.41, 95% CI 6.50 to 27.66), assisted ventilation (adjusted PR=3.12, 95% CI 1.81 to 4.54) and anaemia (adjusted PR=20.82, 95% CI 4.6 to 94.32). Overall birth defect prevalence was higher among Marshallese infants, with a markedly elevated prevalence of neural tube defects (adjusted PR=12.57, 95% CI 1.60 to 98.72). Conclusions: Marshallese mothers and infants in Arkansas experience significant reproductive health disparities, underscoring the need for culturally responsive prenatal care interventions.