Please read the following article and answer the questions below.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651396/

Rates of obstetric intervention during birth and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas.

Dahlen HG, Schmied V, Dennis CL, Thornton C. BMC Pregnancy Childbirth. 2013 May 1;13:100. doi: 10.1186/1471-2393-13-100.

1. What was the aim of the study?

2. What study design was used? Was it appropriate? (Consider the applications of the design, advantages and disadvantages in your justification)

3. Please examine Table 2 from the paper. Calculate the relative risk of Gestational Diabetes Mellitus, Hypertensive diseases of Pregnancy and Preterm birth between Australian and non-Australian born women Please interpret each. Which outcomes are being non-Australian born more strongly associated with? How do you know.

4. Please examine Table 2 from the paper. Which group(Australian and non-Australian) is attributed to the highest amount of Gestational Diabetes Mellitus in the total population? Please generate a 2 x 2 table and show your calculations. Interpret your finding.

5. Continuing on with Table 2, please calculate the 95% CI for the maternal ages of Australian and non-Australian born women. Please interpret the 95% CI.

6. Why is the 95% CI for Australian born women narrower than for the Non-Australian born women? What would happen if the SD for non-Australian born women was 3.58 instead of 5.38 (you do not need to do any calculations)?

7. The study identifies it has a number of limitations. In particular why was the absence of ‘English language fluency, migration from an English speaking country, length of residence, refugee background and factors associated with care such as discrimination and culturally insensitive care' a limitation of this study. How might this limitation influence the findings of the study?

8. The authors conclude that ‘...Indian-born women now the leading migrant group coming into Australia and having the lowest normal birth rate, along with high rates of babies with birth weights <10th and <3rd centile....' What study design would you propose to assess whether Indian mothers really are at higher risk of adverse birth outcomes. (Consider the applications of the design, advantages and disadvantages in your justification)