Abstract
BackgroundTo investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration.MethodsWe included 1,287,270 singleton pregnancies (163,508 to immigrant women) in Norway during 1990–2013. Individual data were obtained through record linkage between the Medical Birth Registry of Norway and Statistics Norway. Analyses were performed for preeclampsia overall and in combination with preterm birth < 37 and < 34 weeks of gestation, referred to as preterm and very preterm preeclampsia. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard errors, adjusted for relevant covariates, including maternal income and education.ResultsPreeclampsia was reported in 3.5% of Norwegian women and 2.5% of immigrants. Compared with Norwegian women, the adjusted OR for preeclampsia was lowest in labour immigrants (adjusted OR 0.55 [95% CI 0.49–0.62]), followed by family immigrants (0.62 [0.59–0.65]), immigrant students (0.75 [0.65–0.86]), refugees (0.81 [0.75–0.88]), and immigrants from other Nordic countries (0.87 [0.80–0.94]). Compared with Norwegian women, labour immigrants also had lower adjusted odds of preterm and very preterm preeclampsia, whereas refugees had increased adjusted odds of preterm and very preterm preeclampsia (< 37 weeks: 1.18 [1.02–1.36], and < 34 weeks: 1.41 [1.15–1.72]).ConclusionsThe occurrence of preeclampsia was lower overall in immigrants than in non-immigrants, but associations varied by maternal reasons for immigration. Maternity caregivers should pay increased attention to pregnant women with refugee backgrounds due to their excess odds of preterm preeclampsia.
Highlights
To investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration
Refugee women giving birth in receiving countries have been found to have higher risks of preterm birth [7], infant mortality and morbidity [8], and postpartum depression [9]. While these findings suggest the need for closer health monitoring of pregnant refugee women in receiving countries, knowledge of health disparities associated with other reasons such as employment, education, family reunion or establishment is lacking
18% (n = 29,422) were to women coming as refugees, 55% (n = 89,523) to family immigrants, 8% (n = 13,618) to labour immigrants, 5% (n = 8351) to immigrant students, and 14% (n = 22,594) were to Nordic immigrant women
Summary
To investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration. Major reasons for immigrating to Norway include employment, education, family reunion or establishment, as well as seeking refuge due to war and political conflicts [1, 2]. These immigration reasons may not be deterministically linked to countries of origin. Refugee women giving birth in receiving countries have been found to have higher risks of preterm birth [7], infant mortality and morbidity [8], and postpartum depression [9] While these findings suggest the need for closer health monitoring of pregnant refugee women in receiving countries, knowledge of health disparities associated with other reasons such as employment, education, family reunion or establishment is lacking
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