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Objective: To assess the risk of severe maternal outcomes among migrant women, considering both their legal status and birthplace; in Europe, migrant women, especially from sub‐Saharan Africa, have higher risks of adverse maternal outcomes compared with non‐migrants and legal status, a component of migrant condition, may be an important, and potentially actionable, risk factor. Design: Prospective cohort study. Setting: Four maternity units around Paris in 2010–12. Sample: A total of 9599 women with singleton pregnancies. Methods: Legal status was categorised 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. Results: Undocumented migrants had resided for less time in France, experienced social isolation, linguistic barriers and poor housing conditions more frequently and had a pre‐pregnancy medical history at lower risk than other migrants. The multivariable analysis showed that 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% 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). Conclusion: Undocumented migrants are the migrant subgroup at highest risk of severe maternal morbidity, whereas 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 sub‐optimal. Undocumented migrants, especially those born in sub‐Saharan Africa, have the highest risk of Severe Maternal Morbidity. Undocumented migrants, especially those born in sub‐Saharan Africa, have the highest risk of Severe Maternal Morbidity. This article includes Author Insights, a video abstract available at: https://vimeo.com/bjog/authorinsights17124 [ABSTRACT FROM AUTHOR]

Background: An increased risk of severe maternal morbidity and mortality has been described in migrant women, particularly in those born in sub-Saharan Africa. The mechanisms in question are poorly identified and rarely studied specifically.Objective: To compare changes in maternal and perinatal morbidity inequalities among migrant and native women over time, between 2008 and 2014.Material and Method: A retrospective, single-centre study carried out at the Maternity Unit of the University of Caen Hospital in France. All women who gave birth in 2008 or 2014 were included. Twin pregnancies and delivery before reaching 22 weeks of pregnancy were excluded. Pre-pregnancy characteristics and maternal and perinatal morbidities were collected from the university hospital's medical and administrative database. We compared the maternal and perinatal morbidity in 2008 and 2014 of women born in France to the morbidity of women born abroad. Secondly, we compared these migrant women between 2008 and 2014 to see if changes in the characteristics of migrant women were associated with a change in the type of maternal and perinatal complications.Results: Of the 3,038 and 3,001 women included in 2008 and 2014, respectively, 272 (9.0 %) and 385 (12.8 %) women were migrants. Compared to women born in France, we found two times more severe postpartum hemorrhages in women born in sub-Saharan Africa (aOR = 2.1[1.1-3.9]) and a significant increase in the risk of gestational diabetes in women born in North Africa (aOR = 1.9[1.2-2.9]). We found a significant increase in the risk of severe postpartum hemorrhage (aOR = 2.1[1.5-3.0]) and gestational diabetes (aOR = 3.0[2.5-3.7]) in 2014 compared to 2008. We did not find a significant difference in perinatal morbidity between 2008 and 2014.Conclusion: We noted a significant increase in the risk of severe postpartum hemorrhage in women born in sub-Saharan Africa and gestational diabetes in women born in North Africa compared to those born in France, and these risks increase in 2014 relative to 2008. [ABSTRACT FROM AUTHOR]