title: Immigrants from conflict-zone countries: an observational comparison study of obstetric outcomes in a low-risk maternity ward in Norway.
abstract: BACKGROUND
  Immigrants have higher risks for some adverse obstetric outcomes. Furthermore, refugees are reported to be the most vulnerable group. This study compared obstetric outcomes between immigrant women originating from conflict-zone countries and ethnic Norwegians who gave birth in a low-risk setting.
  
  
  METHODS
  This was a population-based study linking the Medical Birth Registry of Norway to Statistics Norway. The study included the first registered birth during the study period of women from Somalia (n = 278), Iraq (n = 166), Afghanistan (n = 71), and Kosovo (n = 67) and ethnic Norwegians (n = 6826) at Baerum Hospital from 2006-2010. Background characteristics and obstetric outcomes of each immigrant group were compared with ethnic Norwegians with respect to proportions and risks calculated by logistic regression models.
  
  
  RESULTS
  In total, 7408 women and their births were analyzed. Women from Somalia were most at risk for adverse obstetric outcomes. Compared with ethnic Norwegians, they had increased odds ratios (OR) for emergency cesarean section (OR 1.81, CI 1.17-2.80), postterm birth (OR 1.93, CI 1.29-2.90), meconium-stained liquor (OR 2.39, CI 1.76-3.25), and having a small-for-gestational-age infant (OR 3.97, CI 2.73-5.77). They had a reduced OR for having epidural analgesia (OR 0.40, CI 0.28-0.56) and a large-for-gestational-age infant (OR 0.32, CI 0.16-0.64). Women from Iraq and Afghanistan had increased risk of having a small-for-gestational-age infant with OR of 2.21 (CI 1.36-3.60) and 2.77 (CI 1.42-5.39), respectively. Iraqi women also had reduced odds ratio of having a large-for-gestational-age infant (OR 0.35, CI 0.15-0.83). Women from Kosovo did not differ from ethnic Norwegians in any of the outcomes we tested.
  
  
  CONCLUSIONS
  Even in our low-risk maternity ward, women originating from Somalia were at the greatest risk for adverse obstetric outcomes in the compared groups. We could not find the same risk among the other immigrant women, also originating from conflict-zone countries. Several factors may influence these findings, and this study suggests that immigrant women from Somalia need more targeted care during pregnancy and childbirth.
authors.affiliation: Department of Gynecology and Obstetrics, Baerum Hospital, Vestre Viken Hospital Trust, P.O. Box 800, 3004, Drammen, Norway. kjersti.sletten@gmail.com.|University of Oslo, Faculty of Medicine, Institution of Clinical Medicine, P.O. Box 1171, Blindern, 0318, Oslo, Norway. kjersti.sletten@gmail.com.
authors.forename: Kjersti S
authors.initials: KS
authors.lastname: Bakken
authors.affiliation: Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, 411 19, Göteborg, Sweden. ola.skjeldal@gmail.com.
authors.forename: Ola H
authors.initials: OH
authors.lastname: Skjeldal
authors.affiliation: University of Oslo, Faculty of Medicine, Institution of Clinical Medicine, P.O. Box 1171, Blindern, 0318, Oslo, Norway. babill.stray-pedersen@medisin.uio.no.|Women and Children's Division and Norwegian Resource Centre for Women's Health, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0027, Oslo, Norway. babill.stray-pedersen@medisin.uio.no.
authors.forename: Babill
authors.initials: B
authors.lastname: Stray-Pedersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan / Q000208:ethnology; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004630:Emergencies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007493:Iraq / Q000208:ethnology; D063826:Kosovo / Q000208:ethnology; D016015:Logistic Models; D008470:Meconium; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D011273:Pregnancy, Prolonged / Q000453:epidemiology*; D011446:Prospective Studies; D012306:Risk; D012998:Somalia / Q000208:ethnology; D014857:Warfare; D055815:Young Adult