Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area – a population-based study

Abstract

Background: Studies report that women born in some African countries, after migrating to the Nordic countries, have worse pregnancy outcomes than women born in the receiving countries. With the aim of identifying unmet needs among Somali-born women, we here study this subgroup. Objective: We compared pregnancy outcomes among women born in Somalia to women born in Sweden. Further, we investigated whether the proactive maternal observation of fetal movements has effects on birth outcomes among women born in Somalia. Methods: In Stockholm, half of the maternity clinics were randomized to intervention, in which midwives were instructed to be proactive towards women by promoting daily selfmonitoring of fetal movements. Data for 623 women born in Somalia and 26 485 born in Sweden were collected from a population-based register. Results: An Apgar score below 7 (with stillbirth counting as 0) at 5 minutes was more frequent in babies of women born in Somalia as compared to babies of women born in Sweden (RR 2.17, 95% CI 1.25-3.77). Babies born small for gestational age were more common among women born in Somalia (RR 2.22, CI 1.88-2.61), as were babies born after 41 + 6 gestational weeks (RR 1.65, CI 1.29-2.12). Somali-born women less often contacted obstetric care for decreased fetal movements than did Swedish-born women (RR 0.19, CI 0.08-0.36). The differences between women born in Somalia and women born in Sweden were somewhat lower (not statistically significant) among women allocated to proactivity as compared to the Routine-care group. Conclusions: A higher risk of a negative outcome for mother and baby is seen among women born in Somalia compared to women born in Sweden. We suggest it may be worthwhile to investigate whether a Somali-adapted intervention with proactivity concerning self-monitoring of fetal movements may improve pregnancy outcomes in this migrant population.

Hypoxic ischemic encephalopathy in offspring of immigrant women in Sweden: A population‐based cohort study

“…In line with previous studies, we reported an increased risk of Apgar score <7 at 5 minutes in specific immigrant groups 5,6,26 . Associations that have been suggested are prematurity, post‐term pregnancies, and suboptimal care during pregnancy and in labor 8 .…”

“…In line with previous studies, we reported an increased risk of Apgar score <7 at 5 minutes in specific immigrant groups. 5,6,26 Associations that have been suggested are prematurity, post-term pregnancies, and suboptimal care during pregnancy and in labor. 8 Our material did not include premature births; but post-term pregnancies were more common among women born in low-income countries.…”

“…The immigrant population is diverse and, although some immigrant groups have been found to have better outcomes than the host population, 2 asylum seekers and immigrants from low‐income countries and some specific geographic areas have greater risks of adverse outcomes 2–4 . Higher rates of low birthweight, 5,6 low Apgar score at 5 minutes, 5–7 and perinatal death 2,8 have been reported. Socio‐economics has been put forward as an important explanatory factor for these differences 2,9 .…”

“Womanhood,” a shared experience of participating in a lifestyle intervention with a focus on integration and physical activity to promote health among pregnant women: perspectives from pregnant women, midwives, and cultural interpreter doulas

“…Studies on migrant populations have shown that factors included are the process of migration, exposure to risks and access to the determinants of health in the country of origin (World Health Organization, 2018 ). Moreover, previous studies support that migration and adverse birth outcomes varies by migrant subgroup (Akselsson et al, 2020 ; Gagnon et al, 2011 ; Juarez et al, 2017 ; Urquia et al, 2010 ), with women from low-income countries being particularly vulnerable, having a 6.6 times higher maternal mortality rate compared to Swedish-born women (Esscher et al, 2013 ). Moreover, the destination country and the social circumstances that immigrants encounter in the new country affects immigrant’s health and adoption of unhealthy behaviours (Lindström & Sundquist, 2005; Lopez-Borbon, 2021 ).…”

Drug use during pregnancy with focus on antidepressants

“…For future research, to study the impact of major depression and antidepressant treatment, it would be of interest to study women born outside Sweden who later gave birth in Sweden since we know that migrant women have a higher risk for adverse maternal and neonatal outcomes (147,148).…”