title: Obstetric risks and outcomes of refugee women at a single centre in Toronto.
abstract: OBJECTIVE
  Women 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.
  
  
  METHODS
  Using 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.
  
  
  RESULTS
  Multiparous 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.
  
  
  CONCLUSIONS
  Refugee 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.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Tharani
authors.initials: T
authors.lastname: Kandasamy
authors.affiliation: Department of Medicine, McGill University, Montreal QC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cherniak
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, St. Michael's Hospital, Toronto ON.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Shah
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, St. Michael's Hospital, Toronto ON.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto ON.
authors.forename: Rachel
authors.initials: R
authors.lastname: Spitzer
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D009864:Ontario; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: pregnancy outcomes; preterm delivery; refugee health