Department of Public Health, Aarhus University, Aarhus, Denmark.
Department of Obstetrics and Gynecology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Acta Obstet Gynecol Scand. 2021 Apr;100(4):649-657. doi: 10.1111/aogs.14070. Epub 2021 Jan 23.
Pregnancy is a time of increased vulnerability for women. Women of refugee background may be further challenged in pregnancy due to a complex series of physical, psychological and social factors. Previous studies show ambiguous results, with some showing increased the risk of prenatal complications in refugees compared with their native counterparts, whereas other studies report the opposite. With the current steep rise in the number of refugees and displaced persons worldwide, research is important to understand whether pregnancy disparities between this population and their native counterparts exist, and the causes. This systematic literature review aims to find out whether refugee women have a higher prevalence of adverse pregnancy outcomes and prenatal infections compared with native women.
We conducted a literature search in the databases PubMed and Embase, supplemented with screening of reference lists and citations for relevant literature. We included studies published in English reporting risk of preeclampsia, spontaneous abortion and stillbirths, preterm birth, preterm prelabor rupture of membranes (PPROM) and adverse prenatal infectious diseases in women of refugee status. PROSPERO registration CRD42020205628.
We identified 19 articles eligible for inclusion: 12 were cross-sectional, six were cohort studies and one was a case-control study. The most frequently reported outcome in the literature was preterm birth (reported in 16 of the studies) and preeclampsia (reported in 11 of the studies). Refugees had increased risk of stillbirth (reported relative risk ranging from 1.20 to 2.24) and spontaneous abortion (reported relative risk ranging from 1.56 to 1.58), when compared with native women and a decreased risk of preeclampsia (reported relative risk ranging from 0.65 to 0.81).
The small number of articles eligible for inclusion in the review highlights the lack of research and knowledge on refugee health during pregnancy. Further research is required to understand and reduce disparities in pregnancy outcomes between refugee and non-refugee women.
怀孕对女性来说是一个脆弱的时期。由于一系列复杂的身体、心理和社会因素，难民背景的女性在怀孕期间可能会面临更大的挑战。先前的研究结果并不明确，一些研究表明，与本地女性相比，难民在产前并发症方面的风险增加，而其他研究则报告相反的结果。随着全球难民和流离失所者人数的急剧增加，研究对于了解这一人群与本地女性之间是否存在妊娠差异以及原因非常重要。本系统文献综述旨在探讨难民妇女与本地妇女相比，是否更易出现不良妊娠结局和产前感染。
我们在 PubMed 和 Embase 数据库中进行了文献检索，并补充了相关文献的参考文献和引文筛选。我们纳入了以英文发表的报告难民身份的妇女发生子痫前期、自然流产和死产、早产、早产胎膜早破（PPROM）和不良产前感染性疾病风险的研究。PROSPERO 注册号为 CRD42020205628。
我们确定了 19 篇符合纳入标准的文章：12 篇为横断面研究，6 篇为队列研究，1 篇为病例对照研究。文献中最常报告的结局是早产（16 项研究报告）和子痫前期（11 项研究报告）。与本地妇女相比，难民发生死产（报告的相对风险范围为 1.20 至 2.24）和自然流产（报告的相对风险范围为 1.56 至 1.58）的风险增加，子痫前期的风险降低（报告的相对风险范围为 0.65 至 0.81）。
纳入综述的文章数量较少，这突出表明了在妊娠期间，针对难民健康的研究和知识匮乏。需要进一步研究以了解和减少难民和非难民妇女妊娠结局之间的差异。
