Midwifery · 2025
Variations in severe maternal morbidity between women from refugee backgrounds and Australian-born women in public maternity care: A population-based study in Victoria, Australia.
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Yeshitila Yordanos Gizachew, Gartland Deirdre, Le Ha N D, Gold Lisa, Abimanyi-Ochom Julie, Sweet Linda, Riggs Elisha
Аннотация
BACKGROUND: In high-income countries, maternal mortality and severe morbidity tend to occur more frequently in women from refugee backgrounds, those who have refugee-like experiences; conflict, displacement, persecution, and traumatic experiences related to these, compared to the host country-born populations. This study aimed to investigate the prevalence and risk factors of severe maternal morbidity among women from refugee backgrounds compared to the host country in Victoria, Australia.
METHODS: A population-based cross-sectional study was used to compare singleton births from mothers born in Australia (721,425) to those from women of refugee backgrounds (32,845). Data from the Victorian Perinatal Data Collection, 2003 to 2017, was used. Severe maternal morbidity was defined as admission to an Intensive Care Unit during pregnancy or within 42 days postpartum. Inferential statistics, including Pearson's Chi-square and binary logistic regression, were used to examine differences in adverse perinatal outcomes based on severe morbidity. Multiple logistic regression was conducted to explore the relationship between severe maternal morbidity and risk factors.
RESULTS: The prevalence of severe maternal morbidity was 1.06 (95 % CI: 1.03-1.08), equivalent to 10.73 cases per 1000 births. Notably, women from a refugee background had a higher prevalence of 1.41 (95 % CI: 1.23-1.53) compared to Australian-born women at 1.04 (95 % CI: 1.02-1.07). Adjusting for confounders, eclampsia (AOR 12.4, 95 % CI 9.6-15.8) and puerperal sepsis (AOR 9.6, 95 % CI 6.9-13.3) emerged as the strongest independent predictors. Other factors associated with a higher risk of severe maternal morbidity included socio-economic disadvantage, preexisting diabetes, gestational hypertension, preterm birth, and various obstetric complications such as haemorrhage, preeclampsia, and circulatory conditions during pregnancy and childbirth.
CONCLUSION AND IMPLICATIONS FOR FUTURE RESEARCH: There is an urgent need for targeted interventions to address the disparities in severe maternal morbidity, especially for women from refugee backgrounds and those facing socio-economic challenges.
METHODS: A population-based cross-sectional study was used to compare singleton births from mothers born in Australia (721,425) to those from women of refugee backgrounds (32,845). Data from the Victorian Perinatal Data Collection, 2003 to 2017, was used. Severe maternal morbidity was defined as admission to an Intensive Care Unit during pregnancy or within 42 days postpartum. Inferential statistics, including Pearson's Chi-square and binary logistic regression, were used to examine differences in adverse perinatal outcomes based on severe morbidity. Multiple logistic regression was conducted to explore the relationship between severe maternal morbidity and risk factors.
RESULTS: The prevalence of severe maternal morbidity was 1.06 (95 % CI: 1.03-1.08), equivalent to 10.73 cases per 1000 births. Notably, women from a refugee background had a higher prevalence of 1.41 (95 % CI: 1.23-1.53) compared to Australian-born women at 1.04 (95 % CI: 1.02-1.07). Adjusting for confounders, eclampsia (AOR 12.4, 95 % CI 9.6-15.8) and puerperal sepsis (AOR 9.6, 95 % CI 6.9-13.3) emerged as the strongest independent predictors. Other factors associated with a higher risk of severe maternal morbidity included socio-economic disadvantage, preexisting diabetes, gestational hypertension, preterm birth, and various obstetric complications such as haemorrhage, preeclampsia, and circulatory conditions during pregnancy and childbirth.
CONCLUSION AND IMPLICATIONS FOR FUTURE RESEARCH: There is an urgent need for targeted interventions to address the disparities in severe maternal morbidity, especially for women from refugee backgrounds and those facing socio-economic challenges.