Kandasamy Tharani, Cherniak Rebecca, Shah Rajiv, Yudin Mark H, Spitzer Rachel
Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
Department of Medicine, McGill University, Montreal QC.
J Obstet Gynaecol Can. 2014 Apr;36(4):296-302. doi: 10.1016/S1701-2163(15)30604-6.
Women who are refugees during pregnancy may be exposed to homelessness, poor nutrition, and limited access to health care, yet the pregnancy outcomes of this vulnerable population have not been systematically evaluated. We undertook a study to determine the risk of adverse obstetric and perinatal outcomes among refugee women in Toronto.
Using a retrospective cohort design, we examined pregnancy outcomes for refugee and non-refugee women delivering at St. Michael's Hospital in Toronto, between January 1, 2008, and December 31, 2010. The primary outcome measures were preterm delivery (< 37 weeks' gestational age), low birth weight (< 2500 g), and delivery by Caesarean section.
Multiparous refugee women had a significantly higher rate of delivery by Caesarean section (36.4%), and a 1.5-fold increase in rate of low birth weight infants when compared with non-refugee women. In subgroup analysis by region of origin, women from Sub-Saharan Africa had significantly higher rates of low birth weight infants and Caesarean section than non-refugee control subjects. Further, compared with non-refugee control subjects, refugee women had significantly increased rates of prior Caesarean section, HIV-positive status, homelessness, social isolation, and delays in accessing prenatal care.
Refugee women constitute a higher-risk population with increased rates of adverse obstetric and perinatal outcomes. These findings provide preliminary data to guide targeted public health interventions towards meeting the needs for obstetric care of this vulnerable population. Recent changes to the Interim Federal Health Program have highlighted the importance of identifying and diminishing disparities in health outcomes between refugee and non-refugee populations.
孕期成为难民的女性可能面临无家可归、营养不良以及获得医疗保健的机会有限等情况，但这一弱势群体的妊娠结局尚未得到系统评估。我们开展了一项研究，以确定多伦多难民女性不良产科和围产期结局的风险。
采用回顾性队列设计，我们研究了2008年1月1日至2010年12月31日期间在多伦多圣迈克尔医院分娩的难民和非难民女性的妊娠结局。主要结局指标为早产（孕周<37周）、低出生体重（<2500克）以及剖宫产。
经产妇难民女性的剖宫产率显著更高（36.4%），与非难民女性相比，低出生体重儿的发生率增加了1.5倍。在按原籍地区进行的亚组分析中，撒哈拉以南非洲地区的女性低出生体重儿和剖宫产的发生率显著高于非难民对照对象。此外，与非难民对照对象相比，难民女性既往剖宫产、艾滋病毒阳性状态、无家可归、社会隔离以及获得产前护理延迟的发生率显著增加。
难民女性构成了一个高风险人群，不良产科和围产期结局的发生率更高。这些发现提供了初步数据，以指导有针对性的公共卫生干预措施，满足这一弱势群体的产科护理需求。近期《临时联邦健康计划》的变化凸显了识别和减少难民与非难民人群健康结局差异的重要性。
