title: Contribution of HIV to Maternal Morbidity Among Refugee Women in Canada.
abstract: OBJECTIVE
  We compared severe maternal morbidity (SMM) and SMM subtypes, including HIV, of refugee women with those of nonrefugee immigrant and nonimmigrant women.
  
  
  METHODS
  We linked 1,154,421 Ontario hospital deliveries (2002-2011) to immigration records (1985-2010) to determine the incidence of an SMM composite indicator and its subtypes. We determined SMM incidence according to immigration periods, which were characterized by lifting restrictions for all HIV-positive immigrants (in 1991) and refugees who may place "excessive demand" on government services (in 2002).
  
  
  RESULTS
  Refugees had a higher risk of SMM (17.1 per 1000 deliveries) than did immigrants (12.1 per 1000) and nonimmigrants (12.4 per 1000). Among SMM subtypes, refugees had a much higher risk of HIV than did immigrants (risk ratio [RR] = 7.94; 95% confidence interval [CI] = 5.64, 11.18) and nonimmigrants (RR = 17.37; 95% CI = 12.83, 23.53). SMM disparities were greatest after the 2002 policy came into effect. After exclusion of HIV cases, SMM disparities disappeared.
  
  
  CONCLUSIONS
  An apparent higher risk of SMM among refugee women in Ontario, Canada is explained by their high prevalence of HIV, which increased over time parallel to admission policy changes favoring humanitarian protection.
authors.affiliation: At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Susitha
authors.initials: S
authors.lastname: Wanigaratne
authors.affiliation: At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Cole
authors.affiliation: At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Bassil
authors.affiliation: At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Ilene
authors.initials: I
authors.lastname: Hyman
authors.affiliation: At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Urquia
mesh_terms: D000293:Adolescent; D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D009864:Ontario / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012036:Refugees / Q000706:statistics & numerical data*; D012307:Risk Factors; D055815:Young Adult