Abstract
ObjectivesThere are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries.MethodsA systematic search on the databases of PubMed/MEDLINE, Scopus, and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results.ResultsThe search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups.ConclusionAlthough the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.
Highlights
The number of international immigrants, asylum seekers and refugees from conflict-zone countries, continues to grow rapidly
This systematic review and meta-analysis showed that, among the immigrants from conflict-zone countries, the risk of adverse neonatal outcomes, including small for gestational age (SGA), a 5-min Apgar score
Our review revealed that the risk of maternal outcomes was comparable, but the risk of most serious adverse neonatal outcomes among the immigrant women from conflict-zone countries was significantly higher than those women in host countries
Summary
The number of international immigrants, asylum seekers and refugees from conflict-zone countries, continues to grow rapidly. In Europe, ∼1 in 10 people, is currently an international immigrant [1]. There is no international consensus on the definition of immigrant [1], it could be defined by the length of settlement in the host country, documentation status, voluntary or forced movement, and underlying reasons for immigration [1, 3]. Incorporating the mixed definition for immigration has increased the extent and complexity of this association, which can negatively impact the health status of immigrants in host countries [6]. These differences are more complicated by pregnancy [7]
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