Obstetric Risks and Outcomes of Refugee Women at a Single Centre in Toronto |
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| Affiliation: | 1. Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON;2. Department of Medicine, McGill University, Montreal QC;3. Department of Obstetrics and Gynaecology, University of Toronto, St. Michael’s Hospital, Toronto ON;4. Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto ON;1. VU University Medical Center, the Netherlands;2. Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands;3. Academic Medical Center, Amsterdam, the Netherlands;4. Maxima Medical Center, Veldhoven, the Netherlands;5. Amphia Hospital, Breda, the Netherlands;6. University Medical Center, Groningen, the Netherlands;7. Isala Clinics, Zwolle, the Netherlands;8. St. Elizabeth Hospital, Tilburg, the Netherlands;9. Medical Center, Alkmaar, the Netherlands;10. Erasmus Medical Center, Rotterdam, the Netherlands;11. Catharina Hospital, Eindhoven, the Netherlands;12. University Medical Center, Utrecht, the Netherlands;13. Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands;14. The Robinson Institute, School of Reproductive and Paediatric Health, University of Adelaide, Australia;1. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;2. Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Melbourne, VIC, Australia;3. South Eastern Melbourne Medicare Local, Melbourne, VIC, Australia;4. Monash Women’s Maternity Services, Monash Health, Melbourne, VIC, Australia;5. School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia;6. The Ritchie Centre, Monash University, Melbourne, VIC, Australia;7. Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC, Australia |
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| Abstract: | ObjectivesWomen who are refugees during pregnancy may be exposed to homelessness, poor nutrition, and limited access to health care, yet the pregnancy outcomes of this vulnerable population have not been systematically evaluated. We undertook a study to determine the risk of adverse obstetric and perinatal outcomes among refugee women in Toronto.MethodsUsing a retrospective cohort design, we examined pregnancy outcomes for refugee and non-refugee women delivering at St. Michael’s Hospital in Toronto, between January 1, 2008, and December 31, 2010. The primary outcome measures were preterm delivery (< 37 weeks’ gestational age), low birth weight (< 2500 g), and delivery by Caesarean section.ResultsMultiparous refugee women had a significantly higher rate of delivery by Caesarean section (36.4%), and a 1.5-fold increase in rate of low birth weight infants when compared with non-refugee women. In subgroup analysis by region of origin, women from Sub-Saharan Africa had significantly higher rates of low birth weight infants and Caesarean section than non-refugee control subjects. Further, compared with non-refugee control subjects, refugee women had significantly increased rates of prior Caesarean section, HIV-positive status, homelessness, social isolation, and delays in accessing prenatal care.ConclusionsRefugee women constitute a higher-risk population with increased rates of adverse obstetric and perinatal outcomes. These findings provide preliminary data to guide targeted public health interventions towards meeting the needs for obstetric care of this vulnerable population. Recent changes to the Interim Federal Health Program have highlighted the importance of identifying and diminishing disparities in health outcomes between refugee and non-refugee populations. |
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