title: Maternal health and pregnancy outcomes comparing migrant women born in humanitarian and nonhumanitarian source countries: a retrospective, observational study.
abstract: BACKGROUND
  The relationship between migration and pregnancy outcomes is complex, with little insight into whether women of refugee background have greater risks of adverse pregnancy outcomes than other migrant women. This study aimed to describe maternal health, pregnancy care, and pregnancy outcomes among migrant women from humanitarian and nonhumanitarian source countries.
  
  
  METHODS
  Retrospective, observational study of singleton births, at a single maternity service in Australia 2002-2011, to migrant women born in humanitarian source countries (HSCs, n = 2,713) and non-HSCs (n = 10,606). Multivariable regression analysis assessed associations between maternal HSC-birth and pregnancy outcomes.
  
  
  RESULTS
  Compared with women from non-HSCs, the following were more common in women from HSCs: age < 20 years (0.6 vs 2.9% p < 0.001), multiparity (51 vs 76% p < 0.001), body mass index (BMI) ≥ 25 (38 vs 50% p < 0.001), anemia (3.2 vs 5.9% p < 0.001), tuberculosis (0.1 vs 0.4% p = 0.001), and syphilis (0.4 vs 2.5% p < 0.001). Maternal HSC-birth was independently associated with poor or no pregnancy care attendance (OR 2.5 [95% CI 1.8-3.6]), late first pregnancy care visit (OR 1.3 [95% CI 1.1-1.5]), and postterm birth (> 41 weeks gestation) (OR 2.5 [95% CI 1.9-3.4]). Stillbirth (0.8 vs 1.2% p = 0.04, OR 1.5 [95% CI 1.0-2.4]) and unplanned birth before arrival at the hospital (0.6 vs 1.2% p < 0.001, OR 1.3 [95% CI 0.8-2.1]) were more common in HSC-born women but not independently associated with maternal HSC-birth after adjusting for age, parity, BMI and relative socioeconomic disadvantage.
  
  
  CONCLUSIONS
  These findings suggest areas where women from HSCs may have additional needs in pregnancy compared with women from non-HSCs. Refugee-focused strategies to support engagement in pregnancy care and address maternal health needs would be expected to improve health outcomes in resettlement countries.
authors: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
authors: Melanie E
authors: ME
authors: Gibson-Helm
authors: Monash Health, Clayton, Victoria, Australia.
authors: Helena J
authors: HJ
authors: Teede
authors: Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Dandenong, Victoria, Australia.|South Eastern Melbourne Medicare Local, Dandenong, Victoria, Australia.
authors: I-Hao
authors: IH
authors: Cheng
authors: Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia.
authors: Andrew A
authors: AA
authors: Block
authors: Monash Women's Maternity Services, Monash Health, Clayton, Victoria, Australia.
authors: Michelle
authors: M
authors: Knight
authors: School of Nursing and Midwifery, Monash University Clayton, Victoria, Australia.
authors: Christine E
authors: CE
authors: East
authors: Monash University Clayton, Victoria, Australia.
authors: Euan M
authors: EM
authors: Wallace
authors: Monash Centre for Health Research and Implementation, Monash University Clayton, Victoria, Australia.
authors: Jacqueline A
authors: JA
authors: Boyle
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D000068097:Maternal Health / Q000208:ethnology / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000208:ethnology*; D011295:Prenatal Care; D012036:Refugees / Q000145:classification / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000145:classification / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014171:Transients and Migrants / Q000145:classification / Q000706:statistics & numerical data
keywords: maternal health; migrant; pregnancy care; pregnancy outcomes; refugee