Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Front Public Health. 2022 Mar 11;10:766943. doi: 10.3389/fpubh.2022.766943. eCollection 2022.
There are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries.
A systematic search on the databases of PubMed/MEDLINE, , and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results.
The search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups.
Although the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.
有关来自冲突地区国家的移民的不良妊娠结局风险存在争议。本系统评价和荟萃分析旨在调查与来自冲突地区的移民相比，来自冲突地区的移民与东道国本地出生的妇女在围产期和新生儿结局方面的风险。
在 PubMed/MEDLINE、Embase 和 Web of Science 数据库上进行了系统检索，以检索关于来自索马里、伊拉克、阿富汗、也门、叙利亚、尼日利亚、苏丹、埃塞俄比亚、厄立特里亚、科索沃、乌克兰和巴基斯坦的移民的围产期和新生儿结局的研究。只有发表在英文的同行评审文章被纳入数据分析和研究综合。使用 DerSimonian 和 Laird 以及逆方差方法构建比值比和森林图来评估感兴趣的结果。随机效应模型和 Harbord 检验分别用于解释研究之间的异质性并评估发表偏倚。进一步的敏感性分析有助于验证我们审查结果的可靠性和稳定性。
检索过程确定了 40 项符合条件的研究，涉及 215718 名有冲突地区移民背景的孕妇和 12806469 名本地出生的妇女。新生儿不良结局的风险包括小于胎龄儿（汇总 OR = 1.8，95%CI = 1.6，2.1）、5 分钟 Apgar 评分<7（汇总 OR = 1.4，95%CI = 1.0，2.1）、死产（汇总 OR = 1.9，95%CI = 1.2，3.0）和围产儿死亡率（汇总 OR = 2，95%CI = 1.6，2.5）在移民妇女中明显高于本地出生的妇女。两组的产妇结局风险，包括剖宫产（CS）和紧急 CS、器械分娩、子痫前期和妊娠期糖尿病，相似。
尽管两组的一些不良产妇结局风险相当，但与本地出生的人群相比，来自冲突地区的移民妇女的新生儿死亡率和发病率较高，包括小于胎龄儿、5 分钟 Apgar 评分<7、死产和围产儿死亡率。我们的审查结果表明需要优化医疗保健，并进一步调查移民妇女的长期不良妊娠结局。
