Biro Mary Anne, East Christine
School of Nursing and Midwifery, Clayton Campus, Monash University, Clayton, Victoria, Australia.
Monash Health, Monash Medical Centre, Clayton, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):186-192. doi: 10.1111/ajo.12593. Epub 2017 Mar 13.
Severe fetal growth restriction (FGR) (< third centile) in a singleton pregnancy undelivered by 40 weeks is one of a number of Victorian Perinatal Services Performance Indicators, which aim to provide a measure of the quality and safety of maternity care. Women of refugee background have been found to have poorer perinatal outcomes compared to others and these outcomes can in part be explained by previous history. However, less access to and engagement with pregnancy care may also be contributing factors. This study examined the impact of likely refugee background on severe FGR in a singleton pregnancy undelivered by 40 weeks.
A retrospective study was undertaken utilising data on women who gave birth to a severely growth-restricted infant at Monash Health during January 2013-July 2015. Unadjusted and adjusted analyses were undertaken to examine the association between the mother being of likely refugee background and severe FGR in singletons delivered after 40 weeks.
There was an association between the mother being of likely refugee background and giving birth to a severely growth-restricted baby after 40 weeks with these mothers at two and half times the odds compared to mothers of non-refugee background (adjusted odds ratio 2.52; 95% confidence interval: 1.44-4.42).
While detecting FGR is clinically challenging, our findings suggest that maternity services need to be supported to offer care tailored to the specific needs of vulnerable and disadvantaged populations. Providing quality, culturally responsive and accessible care is fundamental to addressing refugee maternal and perinatal health inequalities.
单胎妊娠且孕40周仍未分娩的严重胎儿生长受限（FGR）（<第三百分位数）是维多利亚州围产期服务绩效指标之一，旨在衡量产科护理的质量和安全性。研究发现，与其他女性相比，有难民背景的女性围产期结局较差，部分原因可归因于既往病史。然而，获得孕期护理的机会较少以及参与度较低也可能是影响因素。本研究调查了可能的难民背景对单胎妊娠且孕40周仍未分娩的严重FGR的影响。
采用回顾性研究，利用2013年1月至2015年7月在莫纳什健康中心出生的严重生长受限婴儿母亲的数据。进行了未调整和调整分析，以研究母亲可能有难民背景与孕40周后分娩的单胎严重FGR之间的关联。
母亲可能有难民背景与孕40周后生下严重生长受限婴儿之间存在关联，这些母亲的几率是非难民背景母亲的2.5倍（调整后的优势比为2.52；95%置信区间：1.44 - 4.42）。
虽然检测FGR在临床上具有挑战性，但我们的研究结果表明，需要支持产科服务，为弱势群体和处境不利人群提供量身定制的护理。提供高质量、具有文化响应性且可及的护理是解决难民孕产妇和围产期健康不平等问题的根本。
