title: Obstetric and Perinatal Morbidity in Northern Tasmanian Aboriginal Population: A Retrospective Cohort Study.
abstract: BACKGROUND
  Aboriginal and Torres Strait Islander women are at increased risk of maternal morbidity and mortality as compared to non-Aboriginals. Similarly, aboriginal babies are at increased risk of low birth weight and infant mortality.
  
  
  OBJECTIVE
  To investigate the independent association of aboriginality with Tasmanian maternal and neonatal morbidity.
  
  
  METHODS
  A retrospective analysis of all the births (gestation more than 20 weeks) from June 2013 to May 2014 was conducted at the Launceston General Hospital, Tasmania. The study compared 66 Aboriginal (4.2% of the total births) to 1477 non-aboriginal births for maternal and neonatal morbidity. Comparisons were made using logistic regression. The outcome measures were maternal and neonatal morbidity.
  
  
  RESULTS
  Significantly higher number of aboriginal women (49% vs 19%; OR 4.15 90%CI 2.52- 6.85) smoked and used illicit drugs (15% vs 2%; OR 9.24; 95%CI 4.28-19.96) than the non-aboriginal women (both p<0.001). Maternal morbidity was not significantly different between aboriginal compared to non-aboriginal women (OR 0.64; 95%CI 0.36-1.14; p=0.13; adjusted OR 1.00; 95%CI 0.52-1.93; p=0.99). Factors positively associated with maternal morbidity included: age (OR 1.28; 95%CI 1.13-1.46; p<0.01) and BMI (OR 1.50; 95%CI 1.33-1.70; p<0.01). The unadjusted OR of neonatal morbidity for aboriginality was 1.98 (95%CI 1.17-3.34; p=0.01) and adjusted was 1.45 (95%CI 0.77-2.72; p=0.25). Factors positively associated with neonatal morbidity included smoking (OR 2.24; 95%CI 1.59-3.14; p<0.01), illicit drug use 95%CI 1.49-(OR 3.26; 95%CI 1.49-7.13; p <0.01), hypertension (OR 2.49; 95%CI 1.61-3.84; p<0.01) and diabetes (OR 1.92; 95%CI 1.33-2.78; p<0.01).
  
  
  CONCLUSIONS
  The composite Aboriginal maternal morbidity does not differ, however the increased rates of smoking and illicit drug use are largely responsible for neonatal morbidity. Along with strengthening strategies to decrease medical comorbidities in aboriginals, we recommend intensifying smoking and illicit drug cessation programs.
authors.affiliation: CMO, Department of Obstetrics and Gynaecology, Joondalup Health Campus , Joondalup Perth WA 6027 Australia .
authors.forename: Rashida
authors.initials: R
authors.lastname: Hakeem
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, UTAS and Senior Staff Specialist LGH , Launceston, Tasmania 7250 Australia .
authors.forename: Amanda
authors.initials: A
authors.lastname: Dennis
authors.affiliation: Senior Lecturer, Launceston Clinical School | School of Medicine , Faculty of Health Sciences, University of Tasmania, Launceston TAS 7250 Australia .
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ogden
authors.affiliation: Research Fellow, School of Health Sciences, University of Tasmania (UTAS) , Launceston, 7250, TAS Australia .
authors.forename: Kiran D K
authors.initials: KD
authors.lastname: Ahuja
authors.affiliation: Neonatal Fellow, Department of Neonatology/Perinatology, KEMH Subiaco Perth WA 6008 Australia .
authors.forename: Mohammed Abdul
authors.initials: MA
authors.lastname: Hakeem
keywords: Maternal; Neonatal; Pregnancy