Immigrants from Conflict-zone Countries: an Observational Comparison Study of Obstetric Outcomes in a Low-risk Maternity Ward in Norway

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2015 Aug 6

PMID 26243275

Citations 18

Authors

Kjersti S Bakken

Ola H Skjeldal

Babill Stray-Pedersen

Affiliations

Soon will be listed here.

Abstract

Background: Immigrants have higher risks for some adverse obstetric outcomes. Furthermore, refugees are reported to be the most vulnerable group. This study compared obstetric outcomes between immigrant women originating from conflict-zone countries and ethnic Norwegians who gave birth in a low-risk setting.

Methods: This was a population-based study linking the Medical Birth Registry of Norway to Statistics Norway. The study included the first registered birth during the study period of women from Somalia (n = 278), Iraq (n = 166), Afghanistan (n = 71), and Kosovo (n = 67) and ethnic Norwegians (n = 6826) at Baerum Hospital from 2006-2010. Background characteristics and obstetric outcomes of each immigrant group were compared with ethnic Norwegians with respect to proportions and risks calculated by logistic regression models.

Results: In total, 7408 women and their births were analyzed. Women from Somalia were most at risk for adverse obstetric outcomes. Compared with ethnic Norwegians, they had increased odds ratios (OR) for emergency cesarean section (OR 1.81, CI 1.17-2.80), postterm birth (OR 1.93, CI 1.29-2.90), meconium-stained liquor (OR 2.39, CI 1.76-3.25), and having a small-for-gestational-age infant (OR 3.97, CI 2.73-5.77). They had a reduced OR for having epidural analgesia (OR 0.40, CI 0.28-0.56) and a large-for-gestational-age infant (OR 0.32, CI 0.16-0.64). Women from Iraq and Afghanistan had increased risk of having a small-for-gestational-age infant with OR of 2.21 (CI 1.36-3.60) and 2.77 (CI 1.42-5.39), respectively. Iraqi women also had reduced odds ratio of having a large-for-gestational-age infant (OR 0.35, CI 0.15-0.83). Women from Kosovo did not differ from ethnic Norwegians in any of the outcomes we tested.

Conclusions: Even in our low-risk maternity ward, women originating from Somalia were at the greatest risk for adverse obstetric outcomes in the compared groups. We could not find the same risk among the other immigrant women, also originating from conflict-zone countries. Several factors may influence these findings, and this study suggests that immigrant women from Somalia need more targeted care during pregnancy and childbirth.

Citing Articles

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References

Porter M, Haslam N . Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA. 2005; 294(5):602-12. DOI: 10.1001/jama.294.5.602. View

Johnson E, Reed S, Hitti J, Batra M . Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state. Am J Obstet Gynecol. 2005; 193(2):475-82. DOI: 10.1016/j.ajog.2004.12.003. View

Saastad E, Vangen S, Froen J . Suboptimal care in stillbirths - a retrospective audit study. Acta Obstet Gynecol Scand. 2007; 86(4):444-50. DOI: 10.1080/00016340701207724. View

Ny P, Dykes A, Molin J, Dejin-Karlsson E . Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden. Acta Obstet Gynecol Scand. 2007; 86(7):805-13. DOI: 10.1080/00016340701415095. View

Rogal S, Poschman K, Belanger K, Howell H, Smith M, Medina J . Effects of posttraumatic stress disorder on pregnancy outcomes. J Affect Disord. 2007; 102(1-3):137-43. PMC: 2150994. DOI: 10.1016/j.jad.2007.01.003. View

Small R, Gagnon A, Gissler M, Zeitlin J, Bennis M, Glazier R . Somali women and their pregnancy outcomes postmigration: data from six receiving countries. BJOG. 2008; 115(13):1630-40. PMC: 2659389. DOI: 10.1111/j.1471-0528.2008.01942.x. View

Malin M, Gissler M . Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health. 2009; 9:84. PMC: 2674879. DOI: 10.1186/1471-2458-9-84. View

Steel Z, Chey T, Silove D, Marnane C, Bryant R, van Ommeren M . Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009; 302(5):537-49. DOI: 10.1001/jama.2009.1132. View

Gagnon A, Zimbeck M, Zeitlin J, Alexander S, Blondel B, Buitendijk S . Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med. 2009; 69(6):934-46. DOI: 10.1016/j.socscimed.2009.06.027. View

10.

Urquia M, Glazier R, Blondel B, Zeitlin J, Gissler M, Macfarlane A . International migration and adverse birth outcomes: role of ethnicity, region of origin and destination. J Epidemiol Community Health. 2009; 64(3):243-51. PMC: 2922721. DOI: 10.1136/jech.2008.083535. View

11.

Urquia M, Frank J, Moineddin R, Glazier R . Immigrants' duration of residence and adverse birth outcomes: a population-based study. BJOG. 2010; 117(5):591-601. PMC: 2848981. DOI: 10.1111/j.1471-0528.2010.02523.x. View

12.

Malmusi D, Borrell C, Benach J . Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010; 71(9):1610-9. DOI: 10.1016/j.socscimed.2010.07.043. View

13.

Thomas P, Beckmann M, Gibbons K . The effect of cultural and linguistic diversity on pregnancy outcome. Aust N Z J Obstet Gynaecol. 2010; 50(5):419-22. DOI: 10.1111/j.1479-828X.2010.01210.x. View

14.

Jamil H, Nassar-McMillanb S, Lambert R, Wangd Y, Ager J, Arnetz B . Pre- and post-displacement stressors and time of migration as related to self-rated health among Iraqi immigrants and refugees in Southeast Michigan. Med Confl Surviv. 2011; 26(3):207-22. PMC: 3055740. DOI: 10.1080/13623699.2010.513655. View

15.

Fernbrant C, Essen B, Ostergren P, Cantor-Graae E . Perceived threat of violence and exposure to physical violence against foreign-born women: a Swedish population-based study. Womens Health Issues. 2011; 21(3):206-13. DOI: 10.1016/j.whi.2010.12.001. View

16.

Yehuda R, Seckl J . Minireview: Stress-related psychiatric disorders with low cortisol levels: a metabolic hypothesis. Endocrinology. 2011; 152(12):4496-503. DOI: 10.1210/en.2011-1218. View

17.

Correa-Velez I, Ryan J . Developing a best practice model of refugee maternity care. Women Birth. 2011; 25(1):13-22. DOI: 10.1016/j.wombi.2011.01.002. View

18.

Urquia M, OCampo P, Heaman M . Revisiting the immigrant paradox in reproductive health: the roles of duration of residence and ethnicity. Soc Sci Med. 2012; 74(10):1610-21. DOI: 10.1016/j.socscimed.2012.02.013. View

19.

Binder P, Johnsdotter S, Essen B . Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context. Soc Sci Med. 2012; 75(11):2028-36. DOI: 10.1016/j.socscimed.2012.08.010. View

20.

Binder P, Borne Y, Johnsdotter S, Essen B . Shared language is essential: communication in a multiethnic obstetric care setting. J Health Commun. 2012; 17(10):1171-86. DOI: 10.1080/10810730.2012.665421. View