Differences in pregnancy outcomes and obstetric care between asylum seeking and resident women: a cross-sectional study in a German federal state, 2010–2016

Abstract

BackgroundDespite large numbers of asylum seekers, there is a lack of evidence on pregnancy outcomes and obstetric care of asylum seeking women in Germany.MethodsCross-sectional study (2010–2016) using administrative data of the main referral hospital for pregnant asylum seekers of the reception center of a large federal state in South Germany. Inclusion criteria: women aged 12–50 years, admitted in relation to pregnancy, childbirth or post-partum complications. Outcomes: differences between asylum seekers and residents in the prevalence of high-risk pregnancy conditions, abortive outcomes/stillbirths, peri- and postnatal maternal complications, neonatal complications, and caesarean sections. Analysis: odds ratios (OR) and 95% confidence intervals (CI) obtained by single and multiple logistic regression analysis. Attributable fractions among the exposed (Afe) and among the total population (Afp) were calculated for selected outcomes.ResultsOf 19,864 women admitted in relation to pregnancy, childbirth or post-partum complications, 2.9% (n = 569) were asylum seekers. Adjusted odds for high-risk pregnancy conditions (OR = 0.76, 95%CI: 0.63–0.91, p < 0.0001), caesarean sections (OR = 0.84, 95%CI 0.66–1.07, p = 0.17) and perinatal complications (OR = 0.65, 95%CI: 0.55–0.78, p < 0.0001) were lower; those for abortive outcomes/stillbirths (OR = 1.58, 95%CI: 1.11–2.20, p = 0.01) and postnatal complications (OR = 1.80, 95%CI: 0.93–3.19, p = 0.06) higher among asylum seeking women relative to residents in models adjusted for age, length of admission, and high-risk pregnancy conditions. The Afe for abortive outcomes and stillbirths among asylum seekers was 40.3% (95% CI, 16.3–56.5) and the Afp was 1.8%. The Afe for postnatal complications was 53.1% (95% CI, 7.1–74.0) and the Afp was 3.1%.ConclusionAsylum seeking women are at higher risk of abortive outcomes/stillbirths and show a tendency towards higher postnatal complications. This excess risk calls for adequate responses by health care providers and policy makers to improve outpatient postnatal care in reception centers and mitigate adverse birth outcomes among asylum seeking women. Although further research is needed, scaling-up midwivery care, improving outreach by maternity care teams, and routinely identifying and addressing mental illness by psychosocial services could be ways forward to improve outcomes in this population.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2053-1) contains supplementary material, which is available to authorized users.

Migrantinnen in der gynäkologisch-/geburtshilflichen Praxis

“…Für die Gruppe der Asylsuchenden zeigen sich Unterschiede in der stationären Aufnahme [10]: vermehrte stationäre Aufnahmen bis zur 25. SSW mit Ausnahme der Altersgruppe 41-50 Jahre (▶ Abb.…”

“…Soziale Unterschiede, Konsanguinität und die unterschiedliche Inanspruchnahme der Schwangerenvorsorge der Immigrantinnen werden hierfür als Ursache genannt [10, 17 -19]. Das Risiko für einen intrauterinen Fruchttod ist bei Flüchtlingen/Asylsuchenden erhöht mit einer Odds Ratio von 1,68 und bei konsanguinen Paaren mit einer Odds Ratio von 2,88 [6,10,19].…”

“…Bozorgmehr et al berichten zudem über signifikant vermehrte postpartale Komplikationen (Odds Ratio 2,13) bei Asylantinnen [10].…”

“…Pränatale stationäre Aufnahme bis 25 Schwangerschaftswochen bei Asylsuchenden (rot) im Vergleich zur einheimischen Bevölkerung (blau) (Bozorgmehr et al[10]). ▶ Tab.…”

Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

“…Additionally, the World Health Organization (WHO) has launched the comprehensive mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) to address the lack of mental health services in humanitarian emergencies, calling for consistent screening and task-shifting to non-specialist health care providers [6]. Efficacious psychological therapies for depression have been evaluated for humanitarian emergencies in low-and middle-income countries [7]; however, forced migrants experience inequitable access to health services relative to the general population [8,9].…”