Embla Ýr Guðmundsdóttir1, Helga Gottfreðsdóttir1,2, Berglind Hálfdánsdóttir1, Marianne Nieuwenhuijze3,4, Mika Gissler5,6,7, Kristjana Einarsdóttir8. 1. Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland. 2. Department of Obstetrics and Gynecology, Women´s Clinic, Landspítali University Hospital, Reykjavík, Iceland. 3. Research Centre for Midwifery Science, Academie Verloskunde Maastricht, Zuyd, the Netherlands. 4. CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands. 5. Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland. 6. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden. 7. Research Centre for Child Psychiatry, University of Turku, Turku, Finland. 8. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
Abstract
INTRODUCTION: This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. MATERIAL AND METHODS: This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, for a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorised into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labour, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a five-minute Apgar < 7, neonatal intensive care unit admission and perinatal mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) for maternal and perinatal outcomes were calculated using logistic regression models. RESULTS: A total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43; 95% CI 1.26 - 1.61, multiparas: 1.39 [1.21 - 1.60]) and instrumental births (primiparas: 1.14 [1.02 - 1.27], multiparas: 1.41 [1.16 - 1.72]) and lower aORs of induction of labour (primiparas: 0.88 [0.79 - 0.98], multiparas: 0.74 [0.66 - 0.83]), compared to Icelandic women. Migrant women from countries with a high Human Development Index score (≥ 0.900) had similar or better outcomes than Icelandic women, whilst migrant women from countries with a lower Human Development Index score than that of Iceland (< 0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency caesarean and postpartum hemorrhage. CONCLUSIONS: Women's citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women. This article is protected by copyright. All rights reserved.
INTRODUCTION: This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. MATERIAL AND METHODS: This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, for a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorised into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labour, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a five-minute Apgar < 7, neonatal intensive care unit admission and perinatal mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) for maternal and perinatal outcomes were calculated using logistic regression models. RESULTS: A total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43; 95% CI 1.26 - 1.61, multiparas: 1.39 [1.21 - 1.60]) and instrumental births (primiparas: 1.14 [1.02 - 1.27], multiparas: 1.41 [1.16 - 1.72]) and lower aORs of induction of labour (primiparas: 0.88 [0.79 - 0.98], multiparas: 0.74 [0.66 - 0.83]), compared to Icelandic women. Migrant women from countries with a high Human Development Index score (≥ 0.900) had similar or better outcomes than Icelandic women, whilst migrant women from countries with a lower Human Development Index score than that of Iceland (< 0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency caesarean and postpartum hemorrhage. CONCLUSIONS:Women's citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women. This article is protected by copyright. All rights reserved.
Authors: Laura Gombau-Giménez; Pilar Almansa-Martínez; María Suarez-Cortés; Alonso Molina-Rodríguez; César Leal-Costa; Ismael Jiménez-Ruiz Journal: Int J Environ Res Public Health Date: 2022-08-16 Impact factor: 4.614