title: Poorer detection rates of severe fetal growth restriction in women of likely refugee background: A case for re-focusing pregnancy care.
abstract: BACKGROUND
  Severe fetal growth restriction (FGR) (< third centile) in a singleton pregnancy undelivered by 40 weeks is one of a number of Victorian Perinatal Services Performance Indicators, which aim to provide a measure of the quality and safety of maternity care. Women of refugee background have been found to have poorer perinatal outcomes compared to others and these outcomes can in part be explained by previous history. However, less access to and engagement with pregnancy care may also be contributing factors. This study examined the impact of likely refugee background on severe FGR in a singleton pregnancy undelivered by 40 weeks.
  
  
  METHODS
  A retrospective study was undertaken utilising data on women who gave birth to a severely growth-restricted infant at Monash Health during January 2013-July 2015. Unadjusted and adjusted analyses were undertaken to examine the association between the mother being of likely refugee background and severe FGR in singletons delivered after 40 weeks.
  
  
  RESULTS
  There was an association between the mother being of likely refugee background and giving birth to a severely growth-restricted baby after 40 weeks with these mothers at two and half times the odds compared to mothers of non-refugee background (adjusted odds ratio 2.52; 95% confidence interval: 1.44-4.42).
  
  
  CONCLUSIONS
  While detecting FGR is clinically challenging, our findings suggest that maternity services need to be supported to offer care tailored to the specific needs of vulnerable and disadvantaged populations. Providing quality, culturally responsive and accessible care is fundamental to addressing refugee maternal and perinatal health inequalities.
authors.affiliation: School of Nursing and Midwifery, Clayton Campus, Monash University, Clayton, Victoria, Australia.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Biro
authors.affiliation: School of Nursing and Midwifery, Clayton Campus, Monash University, Clayton, Victoria, Australia.|Monash Health, Monash Medical Centre, Clayton, Victoria, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: East
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D003430:Cross-Sectional Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007236:Infant, Small for Gestational Age; D010298:Parity; D011247:Pregnancy; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: fetal growth restriction; pregnancy care; refugee