Maternal and infant outcomes of Syrian and Palestinian refugees, Lebanese and migrant women giving birth in a tertiary public hospital in Lebanon: a secondary analysis of an obstetric database

Abstract

ObjectivesThis study aims to assess whether the characteristics, management and outcomes of women varied between Syrian and Palestinian refugees, migrant women of other nationalities and Lebanese women giving birth at a public tertiary centre in Beirut, Lebanon.MethodsThis was a secondary data analysis of routinely collected data from the public Rafik Hariri University Hospital (RHUH) between January 2011 and July 2018. Data were extracted from medical notes using text mining machine learning methods. Nationality was categorised into Lebanese, Syrian, Palestinian and migrant women of other nationalities. The main outcomes were diabetes, pre-eclampsia, placenta accreta spectrum, hysterectomy, uterine rupture, blood transfusion, preterm birth and intrauterine fetal death. Logistic regression models estimated the association between nationality and maternal and infant outcomes, and these were presented using ORs and 95% CIs.Results17 624 women gave birth at RHUH of whom 54.3% were Syrian, 39% Lebanese, 2.5% Palestinian and 4.2% migrant women of other nationalities. The majority of women had a caesarean section (73%) and 11% had a serious obstetric complication. Between 2011 and 2018, there was a decline in the use of primary caesarean section (caesarean section performed for the first time) from 7% to 4% of births (p<0.001). The odds of preeclampsia, placenta abruption and serious complications were significantly higher for Palestinian and migrant women of other nationalities compared to Lebanese women, but not for Syrian women. Very preterm birth was higher for Syrians (OR: 1.23, 95% CI: 1.08 to 1.40) and migrant women of other nationalities (OR: 1.51, 95% CI: 1.13 to 2.03) compared to Lebanese women.ConclusionSyrian refugees in Lebanon had similar obstetric outcomes compared to the host population, except for very preterm birth. However, Palestinian women and migrant women of other nationalities appeared to have worse pregnancy complications than the Lebanese women. There should be better healthcare access and support for migrant populations to avoid severe complications of pregnancy.

A comprehensive evaluation of pregnancy and newborn outcomes in Syrian refugees in Turkey

“…In the < 20 age group, the 1st minute mean APGAR score (6.91 ± 0.69) was signi cantly lower than that in the other age groups (p < 0.001). While neonatal NICU admission rates were higher in the < 20 age group (7.1%) than in the other two groups (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)4.49% and > 35, 4.20%), there was no signi cant difference (p = 0.12).…”

“…Many studies report poor reproductive health outcomes such as preterm birth, increased incidence of cesarean section (CS), intrapartum hemorrhage, gestational diabetes, and puerperal infections among refugee women in different countries. In addition, infants of refugee mothers have been shown to have adverse neonatal outcomes such as low birth weight (LBW), long hospital stays, low appearance of the newborn at the 1st and 5th minutes, Pulse, Grimace Response, Activity, and Respiration (APGAR) scores [2,8,9].…”

Maternal Health Outcomes in the context of fragility: A Retrospective Study from Lebanon

“…While there are several studies re ecting the state of maternal health in Lebanon (29,(33)(34)(35)(36), very few focus on recent health data of disadvantaged women, particularly in primary healthcare settings (37,38).…”

Development and validation of a short tool to assess the awareness of hypertensive disorders of pregnancy: a cross-sectional study among pregnant women in Lebanon

“… 25 As a result, many cases of pregnancy hypertension go undiagnosed until they become severe and life-threatening. 26 Furthermore, cultural and social beliefs may play a role in limiting awareness of HDPs. 27 For example, some women may believe that high blood pressure during pregnancy is normal and do not seek medical attention until complications arise.…”