title: Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state.
abstract: OBJECTIVE
  The purpose of this study was to compare maternal and neonatal morbidity among Somali immigrants, US-born blacks and whites in Washington state.
  
  
  METHODS
  Washington state birth certificate data was linked to hospital discharge records comparing singleton deliveries among Somali immigrants with US-born blacks and whites between 1993 and 2001, in a 1:3 ratio. Outcomes were compared using unconditional multiple logistic regression models calculating odds ratios (ORs), and 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Five hundred seventy-nine pregnancies from Somali women were compared with 2384 and 2435 pregnancies from black and white women, respectively. Nulliparous Somali women were more likely to have a cesarean delivery than black or white control women, OR 1.6 (95% CI, 1.1-2.3) and 2.0 (95% CI, 1.4-2.8), respectively. Among all women who had cesarean deliveries, Somali women more commonly had cesarean deliveries associated with fetal distress and failed induction of labor. They were 9 times more likely than both control groups to deliver after 42 weeks gestation, and 4 times more likely than black women and 8 times more likely than white women to have oligohydramnios. Somali women were more likely to have gestational diabetes and significant perineal lacerations, and less likely to smoke. Newborns of Somali women were at increased risk for prolonged hospitalization, lower 5-minute Apgar scores, assisted ventilation, and meconium aspiration.
  
  
  CONCLUSIONS
  Pregnancy outcomes should be evaluated within ethnically and culturally unique groups; Somali immigrants are a high-risk subpopulation.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington Medical Center, Harborview Medical Center, Seattle, USA.
authors.forename: E Blair
authors.initials: EB
authors.lastname: Johnson
authors.forename: Susan D
authors.initials: SD
authors.lastname: Reed
authors.forename: Jane
authors.initials: J
authors.lastname: Hitti
authors.forename: Maneesh
authors.initials: M
authors.lastname: Batra
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000208:ethnology; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000208:ethnology; D016104:Oligohydramnios / Q000208:ethnology; D010502:Perineum; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D011256:Pregnancy Outcome / Q000208:ethnology*; D012998:Somalia / Q000208:ethnology; D014861:Washington / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data