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Giuseppe Caruso,1 Eleonora Marcoccia,1,2 Roberto Brunelli,1 Miriam Candelieri,1 Michele Carlo Schiavi,1 Ilaria Zannini,1 Seila Perrone,1 Oriana Capri,1 Ludovico Muzii,1 Giuseppina Perrone,1 Paola Galoppi1 1Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy; 2Department of Experimental Medicine, Sapienza University of Rome, Umberto I Hospital, Rome, ItalyCorrespondence: Giuseppe CarusoDepartment of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Viale del Policlinico, 155, Rome, 00161, ItalyTel +39064463069; +390649972568Email g.caruso@uniroma1.itIntroduction: The ever-increasing wave of immigration in Italy has posed demanding challenges in the management of the new multiethnic obstetric population. The aim of this study was to compare pregnancy and perinatal outcomes between immigrants and the native population in an Italian public hospital.Materials and Methods: Singleton pregnant women (≥ 24 weeks of gestation) who delivered during a 3-year period in an Italian free care hospital were included. Long-term (≥ 2 years of residence) immigrant patients were divided into 4 groups according to their ethnic origin: Europeans, Asians, Latin Americans, and Africans. Perinatal indicators of obstetric outcomes were collected and compared between immigrants and Italians.Results: Of the 3556 patients included, 1092 were immigrants and 2464 Italians. The immigrant cohort experienced a higher rate of macrosomia (1.8% vs 0.6%; p = 0.001), very low birth weight (1.3% vs 0.6%; p = 0.048), very early preterm delivery (1.4% vs 0.4%; p = 0.048), and gestational diabetes mellitus (1.8% vs 0.5%; p = 003) compared with the native population. The overall rate of cesarean sections was greater among Italians (56% vs 45.8%; p < 0.001). Among ethnic groups, Europeans and Latin Americans reported a higher rate of preterm delivery (20.2% and 19%, respectively; p < 0.001). Latin Americans carried also a greater risk of fetal macrosomia (3.6%; p < 0.008), while the rate of very low birth weight was higher among Europeans and Africans (2% and 1.8%, respectively; p < 0.04).Conclusion: Obstetricians should pay special attention to the potential disparities in pregnancy outcomes between immigrants and the native population. Future efforts should focus on reducing preterm delivery and glucose dysmetabolism among pregnant immigrants.Keywords: ethnic disparities, immigration, maternal outcomes, neonatal outcomes, pregnancy