Ramadan Marwa, Shapiro Gabriel D, Yang Seungmi, Ng Edward, Vissandjée Bilkis, Vang Zoua M
Department of Sociology, McGill University, Montreal, Quebec, Canada.
Department of Community Medicine, Alexandria University, Alexandria, Egypt.
PLoS One. 2025 Apr 29;20(4):e0321453. doi: 10.1371/journal.pone.0321453. eCollection 2025.
Refugees often face increased risks of poor perinatal health outcomes compared to native-born individuals and non-refugee immigrants. However, limited research has explored how birth outcomes vary across refugee subgroups in Canada, especially compared to economic immigrants and among refugee groups themselves. This study aimed to (1) compare the risk of preterm birth (PTB), small-for-gestational-age (SGA), large-for-gestational-age (LGA), stillbirth, and infant mortality between refugee subgroups and economic immigrants, and (2) examine differences among Government-Assisted Refugees (GARs), Privately Sponsored Refugees (PSRs), and In-Canada Refugees (ICRs).
This population-based study used data from the Migrant Maternal and Infant Morbidity and Mortality (MIMMM) dataset, including 706,620 singleton births from 2000 to 2017. Generalized estimating equation models calculated adjusted risk ratios (aRRs) for birth outcomes, accounting for maternal and immigration-related factors.
All refugee subgroups had higher PTB (6.26-6.41 per 100 births) and LGA rates (8.65-9.17 per 100 births) but lower SGA rates (9.53-10.40 per 100 births) compared to economic immigrants (PTB: 5.95, LGA: 7.36, SGA: 10.96). After adjustment, GARs maintained higher PTB risks, and all refugee subgroups had lower SGA and higher LGA risks than economic immigrants. Within refugee subgroups, ICRs had higher SGA risks (aRR = 1.09; 95% CI: 1.04-1.14) than GARs, and PSRs (aRR = 1.22; 95% CI: 1.04-1.44) and ICRs (aRR = 1.28; 95% CI: 1.07-1.52) had higher stillbirth risks than GARs.
Refugee women in Canada have higher risks of PTB and LGA births compared to economic immigrants. ICRs had higher risks of SGA births and stillbirths than other refugee subgroups but lower risks of SGA and stillbirths compared to economic immigrants. These disparities are partly explained by maternal and immigration-related factors. Further research is needed to better understand these factors and inform policies aimed at reducing health disparities among immigrant populations in Canada.
与本地出生的人及非难民移民相比，难民往往面临围产期健康不良后果风险增加的情况。然而，在加拿大，针对难民亚群体间出生结局如何不同的研究有限，特别是与经济移民相比以及在难民群体自身之间。本研究旨在：（1）比较难民亚群体与经济移民之间早产（PTB）、小于胎龄儿（SGA）、大于胎龄儿（LGA）、死产和婴儿死亡的风险；（2）研究政府协助难民（GARs）、私人赞助难民（PSRs）和加拿大境内难民（ICRs）之间的差异。
这项基于人群的研究使用了移民孕产妇和婴儿发病率及死亡率（MIMMM）数据集的数据，包括2000年至2017年的706,620例单胎分娩。广义估计方程模型计算出生结局的调整风险比（aRRs），同时考虑孕产妇和移民相关因素。
与经济移民（PTB：5.95，LGA：7.36，SGA：10.96）相比，所有难民亚群体的PTB（每100例分娩6.26 - 6.41例）和LGA率（每100例分娩8.65 - 9.17例）更高，但SGA率（每100例分娩9.53 - 10.40例）更低。调整后，GARs的PTB风险仍然较高，并且所有难民亚群体的SGA风险低于经济移民，LGA风险高于经济移民。在难民亚群体中，ICRs的SGA风险（aRR = 1.09；95% CI：1.04 - 1.14）高于GARs，PSR（aRR = 1.22；95% CI：1.04 - 1.44）和ICRs（aRR = 1.28；95% CI：1.07 - 1.52）的死产风险高于GARs。
与经济移民相比，加拿大的难民妇女发生PTB和LGA分娩的风险更高。ICRs发生SGA分娩和死产的风险高于其他难民亚群体，但与经济移民相比，SGA和死产风险更低。这些差异部分由孕产妇和移民相关因素解释。需要进一步研究以更好地理解这些因素，并为旨在减少加拿大移民人群健康差异的政策提供信息。
