Maternal health and pregnancy outcomes among women of refugee background from African countries: a retrospective, observational study in Australia

BMC Pregnancy and Childbirth

Jacqueline Boyle¹  Euan M Wallace⁶  Christine East³  Michelle Knight²  Andrew Block⁴  Helena Teede⁵  Melanie Gibson-Helm¹ 

[1] Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;Monash Women’s Maternity Services, Monash Health, Melbourne, Australia;School of Nursing and Midwifery, Monash University, Melbourne, Australia;Refugee Health Service, Monash Health, Melbourne, Australia;Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia;The Ritchie Centre, Monash University, Melbourne, Australia

关键词: Perinatal;    Obstetric outcomes;    Antenatal;    Migrant;    Maternal health;    Pregnancy care;    Birth;    Pregnancy;    Africa;    Refugee;   

Others  :  1091464
DOI  :  10.1186/s12884-014-0392-0

 received in 2014-06-30, accepted in 2014-11-11,  发布年份 2014

【 摘 要 】

Background

Women of refugee background from Africa are reported to have a greater risk of adverse pregnancy outcomes compared to women born in resettlement countries. However, there is currently little insight into whether adverse pregnancy outcomes are more common among migrant women of refugee background, compared to women who have migrated for non-humanitarian reasons. To inform whether women of refugee background require additional services in pregnancy compared to non-refugee migrant women from similar world regions we aimed to describe and compare maternal health, pregnancy care attendance and pregnancy outcomes among migrant women from Africa with or without a refugee background.

Methods

Retrospective, observational study of singleton births at a single, metropolitan, maternity service in Australia 2002–2011, to women born in humanitarian source countries (HSC) and non-HSC from North Africa (n = 1361), Middle and East Africa (n = 706) and West Africa (n = 106).

Results

Compared to non-HSC groups, age < 20 years (0–1.4% vs 2.3-13.3%), living in relatively socio-economically disadvantaged geographic areas (26.2-37.3% vs 52.9-77.8%) and interpreter need (0–23.9% vs 9.7-51.5%) were generally more common in the HSC groups. Compared to non-HSC groups, female genital mutilation (0.3-3.3% vs 5.1-13.8%), vitamin D insufficiency (8.7-21.5% vs 23.3-32.0%), syphilis (0–0.3% vs 1.2-7.5%) and hepatitis B (0–1.1% vs 1.2-18%) were also generally more common among the HSC groups. Unplanned birth before arrival at the hospital (3.6%) was particularly high in the North African HSC group. HSC-birth was associated with gestational diabetes mellitus (odds ratio = 3.5, 95% confidence interval: 1.8-7.1) among women from Middle and East Africa, after adjusting for maternal age, parity, body mass index and relative socio-economic disadvantage of area of residence. The West African HSC group had the highest stillbirth incidence (4.4%).

Conclusions

Migrant women of refugee background from different African regions appear to be at greater risk of specific adverse pregnancy outcomes compared to migrant women without a refugee background. Awareness of differing risks and health needs would assist provision of appropriate pregnancy care to improve the health of African women and their babies.

【 授权许可】

   
2014 Gibson-Helm et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1][http://www.immi.gov.au/media/publications/pdf/hp-client-info-paper.pdf] webcite Australian Government Department of Immigration and Citizenship: Australia’s Humanitarian Program - Information Paper. []
• [2]Global Trends 2012 In Global Trends. UNHCR, Geneva, Switzerland; 2013.
• [3]Gissler M, Alexander S, MacFarlane A, Small R, Stray-Pedersen B, Zeitlin J, Zimbeck M, Gagnon A: Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstet Gynecol Scand 2009, 88(2):134-148.
• [4]Lalchandani S, MacQuillan K, Sheil O: Obstetric profiles and pregnancy outcomes of immigrant women with refugee status. Ir Med J 2001, 94(3):79-80.
• [5]Essén B, Hanson BS, Östergren PO, Lindquist PG, Gudmundsson S: Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden. Acta Obstet Gynecol Scand 2000, 79(9):737-743.
• [6]Small R, Gagnon A, Gissler M, Zeitlin J, Bennis M, Glazier R, Haelterman E, Martens G, McDermott S, Urquia M, Vangen S: Somali women and their pregnancy outcomes postmigration: data from six receiving countries. BJOG 2008, 115(13):1630-1640.
• [7]Ravelli AC, Tromp M, Eskes M, Droog JC, van der Post JA, Jager KJ, Mol BW, Reitsma JB: Ethnic differences in stillbirth and early neonatal mortality in the Netherlands. J Epidemiol Community Health 2011, 65(8):696-701.
• [8]Ekeus C, Cnattingius S, Essen B, Hjern A: Stillbirth among foreign-born women in Sweden. Eur J Public Health 2011, 21(6):788-792.
• [9]Zeitlin J, Combier E, De Caunes F, Papiernik E: Socio-demographic risk factors for perinatal mortality. A study of perinatal mortality in the French district of Seine-Saint-Denis. Acta Obstet Gynecol Scand 1998, 77(8):826-835.
• [10]Gagnon AJ, Zimbeck M, Zeitlin J, Alexander S, Blondel B, Buitendijk S, Desmeules M, Di Lallo D, Gagnon A, Gissler M, Glazier R, Heaman M, Korfker D, Macfarlane A, Ng E, Roth C, Small R, Stewart D, Stray-Pederson B, Urquia M, Vangen S: Migration to western industrialised countries and perinatal health: a systematic review. Soc Sci Med 2009, 69(6):934-946.
• [11]Malin M, Gissler M: Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health 2009, 9:84. BioMed Central Full Text
• [12]Zanconato G, Iacovella C, Parazzini F, Bergamini V, Franchi M: Pregnancy outcome of migrant women delivering in a public institution in northern Italy. Gynecol Obstet Invest 2011, 72(3):157-162.
• [13]Urquia ML, Glazier RH, Blondel B, Zeitlin J, Gissler M, Macfarlane A, Ng E, Heaman M, Stray-Pedersen B, Gagnon AJ: International migration and adverse birth outcomes: role of ethnicity, region of origin and destination. J Epidemiol Community Health 2010, 64(3):243-251.
• [14]Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M: Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet 2006, 367(9525):1835-1841.
• [15][http://www.health.vic.gov.au/diversity/refugee.htm] webcite Victorian Department of Health: The Victorian refugee and asylum seeker health action plan 2014–2018. []
• [16][http://www.immi.gov.au/settlement/] webcite Australian Government Department of Immigration and Citizenship: Settlement Reporting Facility. []
• [17]Gibson-Helm M, Boyle J, Block A, Teede H: Use of country of birth as an indicator of refugee background in health datasets. BMC Med Res Methodol 2014, 14(1):27. BioMed Central Full Text
• [18][http://unstats.un.org/unsd/methods/m49/m49regin.htm] webcite United Nations Statistics Division: Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. []
• [19][http:/ / www.abs.gov.au/ AUSSTATS/ abs@.nsf/ Lookup/ 2039.0Main+Features12006?OpenDocume nt] webcite Australian Bureau of Statistics: An Introduction to Socio-Economic Indexes for Areas (SEIFA) 2006. []
• [20][http://www.aihw.gov.au/mothers-and-babies/] webcite Li Z, Zeki R, Hilder L, Sullivan EA: Australia’s mothers and babies 2010. []
• [21]Essen B, Bodker B, Sjoberg NO, Langhoff-Roos J, Greisen G, Gudmundsson S, Ostergren PO: Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? BJOG 2002, 109(6):677-682.
• [22]Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, Gibbons K, Coory M, Gordon A, Ellwood D, McIntyre HD, Fretts R, Ezzati M: Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011, 377(9774):1331-1340.
• [23]Khashan AS, Kenny LC: The effects of maternal body mass index on pregnancy outcome. Eur J Epidemiol 2009, 24(11):697-705.
• [24]Goldenberg RL, McClure EM, Saleem S, Reddy UM: Infection-related stillbirths. Lancet 2010, 375(9724):1482-1490.
• [25]Carolan M: Pregnancy health status of sub-Saharan refugee women who have resettled in developed countries: a review of the literature. Midwifery 2010, 26(4):407-414.
• [26]Lindsay KL, Gibney ER, McAuliffe FM: Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. J Hum Nutr Diet 2012, 25(6):534-546.
• [27]Australian Health Ministers’ Advisory Council: Clinical Practice Guidelines: Antenatal Care – Module 1. In Edited by Australian Government Department of Health and Ageing. Canberra: Australian Government Department of Health and Ageing; 2012.
• [28]Carolan M, Cassar L: Pregnancy care for African refugee women in Australia: attendance at antenatal appointments. Evid Based Midwifery 2007, 5(2):54-58.
• [29]Correa-Velez I, Ryan J: Developing a best practice model of refugee maternity care. Women Birth 2012, 25(1):13-22.
• [30]Balaam MC, Akerjordet K, Lyberg A, Kaiser B, Schoening E, Fredriksen AM, Ensel A, Gouni O, Severinsson E: A qualitative review of migrant women’s perceptions of their needs and experiences related to pregnancy and childbirth. J Adv Nurs 2013, 69(9):1919-1930.
• [31]Carolan M, Cassar L: Antenatal care perceptions of pregnant African women attending maternity services in Melbourne, Australia. Midwifery 2010, 26(2):189-201.
• [32]Anna V, Van Der Ploeg HP, Cheung NW, Huxley RR, Bauman AE: Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care 2008, 31(12):2288-2293.
• [33]Teh WT, Teede HJ, Paul E, Harrison CL, Wallace EM, Allan C: Risk factors for gestational diabetes mellitus: Implications for the application of screening guidelines. Aust N Z J Obstet Gynaecol 2011, 51(1):26-30.
• [34]Wasse H, Holt VL, Daling JR: Pregnancy risk factors and birth outcomes in Washington State: a comparison of Ethiopian-born and US-born women. Am J Public Health 1994, 84(9):1505-1507.
• [35]Johnson EB, Reed SD, Hitti J, Batra M: Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state. Am J Obstet Gynecol 2005, 193(2):475-482.
• [36]Wuest S, Raio L, Wyssmueller D, Mueller MD, Stadlmayr W, Surbek DV, Kuhn A: Effects of female genital mutilation on birth outcomes in Switzerland. BJOG 2009, 116(9):1204-1209.
• [37]Al-Hussaini TK: Female genital cutting: types, motives and perineal damage in laboring Egyptian women. Med Princ Pract 2003, 12(2):123-128.
• [38]Gagnon AJ, Van Hulst A, Merry L, George A, Saucier JF, Stanger E, Wahoush O, Stewart DE: Cesarean section rate differences by migration indicators. Arch Gynecol Obstet 2013, 287(4):633-639.
• [39]Vangen S, Stoltenberg C, Skrondal A, Magnus P, Stray-Pedersen B: Cesarean section among immigrants in Norway. Acta Obstet Gynecol Scand 2000, 79(7):553-558.
• [40]Jiménez-Puente A, Benítez-Parejo N, Del Diego-Salas J, Rivas-Ruiz F, Maañón-Di Leo C: Ethnic differences in the use of intrapartum epidural analgesia. BMC Health Serv Res 2012, 12:207. BioMed Central Full Text
• [41]Murray L, Windsor C, Parker E, Tewfik O: The experiences of African women giving birth in Brisbane, Australia. Health Care Women Int 2010, 31(5):458-472.
• [42]Rodie VA, Thomson AJ, Norman JE: Accidental out-of-hospital deliveries: an obstetric and neonatal case control study. Acta Obstet Gynecol Scand 2002, 81(1):50-54.
• [43]Bhoopalam PS, Watkinson M: Babies born before arrival at hospital. BJOG 1991, 98(1):57-64.
• [44]Loughney A, Collis R, Dastgir S: Birth before arrival at delivery suite: associations and consequences. Br J Midwifery 2006, 14(4):204-208.
• [45]Cacciani L, Asole S, Polo A, Franco F, Lucchini R, De Curtis M, Di Lallo D, Guasticchi G: Perinatal outcomes among immigrant mothers over two periods in a region of central Italy. BMC Public Health 2011, 11:294.