Addressing vulnerability of pregnant refugees

Malebranche, Mary; Nerenberg, Kara; Metcalfe, Amy; Fabreau, Gabriel

doi:10.2471/blt.17.193664

Cited by 17 publications

(24 citation statements)

References 6 publications

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“…5,6 A few studies have shown that exposures during and after migration increase the risk of serious pregnancy complications such as preterm birth, spontaneous abortion, stillbirth, preterm prelabor rupture of membranes (PPROM) and preeclampsia. 3,7,8 Infectious diseases are a significant health issue faced by refugees. Compared with a native population, the risk of transmission is increased in refugee populations, likely due to low health literacy, poor sanitation and crowded living conditions.…”

Section: Introductionmentioning

confidence: 99%

“…For pregnant refugee women this may lead to lack of adequate prenatal care and further increase the risk of complications during pregnancy 5,6 . A few studies have shown that exposures during and after migration increase the risk of serious pregnancy complications such as preterm birth, spontaneous abortion, stillbirth, preterm prelabor rupture of membranes (PPROM) and preeclampsia 3,7,8 …”

Section: Introductionmentioning

confidence: 99%

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Pregnancy complications among refugee women: A systematic review

Harakow

Hvidman

Wejse

et al. 2021

Acta Obstet Gynecol Scand

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Introduction 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. Material and methods 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. Results 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). Conclusions 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy complications among refugee women: A systematic review

Harakow

Hvidman

Wejse

et al. 2021

Acta Obstet Gynecol Scand

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“…Immigrants vary in health and disease compared with individuals born in the receiving countries [ 3 , 4 ]. In terms of immigration reasons, individuals with a refugee background are considered a particularly vulnerable group and refugee background has been associated with several adverse outcomes in both pregnant and non-pregnant individuals [ 5 , 6 ]. In particular, refugee women giving birth in receiving countries have been found to have higher risks of preterm birth [ 7 ], infant mortality and morbidity [ 8 ], and postpartum depression [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Preeclampsia by maternal reasons for immigration: a population-based study

Nilsen

Vik

Rasmussen

et al. 2018

BMC Pregnancy Childbirth

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BackgroundTo investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration.MethodsWe included 1,287,270 singleton pregnancies (163,508 to immigrant women) in Norway during 1990–2013. Individual data were obtained through record linkage between the Medical Birth Registry of Norway and Statistics Norway. Analyses were performed for preeclampsia overall and in combination with preterm birth < 37 and < 34 weeks of gestation, referred to as preterm and very preterm preeclampsia. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard errors, adjusted for relevant covariates, including maternal income and education.ResultsPreeclampsia was reported in 3.5% of Norwegian women and 2.5% of immigrants. Compared with Norwegian women, the adjusted OR for preeclampsia was lowest in labour immigrants (adjusted OR 0.55 [95% CI 0.49–0.62]), followed by family immigrants (0.62 [0.59–0.65]), immigrant students (0.75 [0.65–0.86]), refugees (0.81 [0.75–0.88]), and immigrants from other Nordic countries (0.87 [0.80–0.94]). Compared with Norwegian women, labour immigrants also had lower adjusted odds of preterm and very preterm preeclampsia, whereas refugees had increased adjusted odds of preterm and very preterm preeclampsia (< 37 weeks: 1.18 [1.02–1.36], and < 34 weeks: 1.41 [1.15–1.72]).ConclusionsThe occurrence of preeclampsia was lower overall in immigrants than in non-immigrants, but associations varied by maternal reasons for immigration. Maternity caregivers should pay increased attention to pregnant women with refugee backgrounds due to their excess odds of preterm preeclampsia.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2034-4) contains supplementary material, which is available to authorized users.

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“…Evidence was evaluated with the aim to identify which women are defined as vulnerable. Authors reported examples of social groups that were identified as vulnerable due to different reasons 9 , 18 , 19 , 24 - 26 . These social groups have been reported into six matrices, called matrices of vulnerable populations.…”

Section: Resultsmentioning

confidence: 99%

Women’s vulnerability within the childbearing continuum: A scoping review

Colciago¹,

Merazzi²,

Panzeri³

et al. 2020

Eur J Midwifery

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INTRODUCTION The aim of this scoping review is to explore the concept of ‘vulnerability’ affecting pregnant women and to identify an appropriate definition of this term. METHODS Five stages were adopted for conducting the scoping review. A literature search was undertaken between 1 October 2017 and 5 January 2018, using three databases. Relevant publications were appraised, and semantic content analysis was performed to identify emergent themes and four determinants of the vulnerability concept. This involved combining items that seem to address the same issue. RESULTS Eleven publications were considered, and eight definitions of vulnerability were identified, and from these four themes emerged: poor health outcome or status; exposure to risk; complex social needs; and lack of resources. Further analysis of evidence found examples of groups of people considered to be vulnerable; they were reported into six matrices, mainly with social and psychological difficulties. From these, eleven themes arose. Following a semantic and content analysis of all themes, thirteen final themes were identified. They represent the characteristics associated with women considered to be vulnerable and are called indices of vulnerability. Semantic and content analysis allowed addressing the thirteen indices of vulnerability into four categories called determinants of the vulnerability concept: deficiency, need, risk exposure, and barriers. CONCLUSIONS The vulnerability could be defined as a lack of health, related to the presence of at least one of the four determinants. Midwives are the key to identify vulnerable women, offering appropriate care.

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Addressing vulnerability of pregnant refugees

Cited by 17 publications

References 6 publications

Pregnancy complications among refugee women: A systematic review

Pregnancy complications among refugee women: A systematic review

Preeclampsia by maternal reasons for immigration: a population-based study

Women’s vulnerability within the childbearing continuum: A scoping review

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