Pregnancy complications among refugee women: a systematic review

INTRODUCTION: Pregnancy is a time of increased vulnerability for women. Women of refugee background may be further challenged in pregnancy due to a complex series of physical, psychological and social factors. Previous studies show ambiguous results, with some showing increased the risk of prenatal complications in refugees compared to their native counterpart, while other studies report the opposite. With the current steep rise in the number of refugees and displaced persons worldwide, research is important to understand if pregnancy disparities between this population and their native counterparts exist and their causes. This systematic literature review aims to find out whether refugee women have a higher prevalence of adverse pregnancy outcomes and prenatal infections compared to native women. MATERIAL AND METHODS: We conducted a literature search in the databases PubMed and Embase, supplemented with screening of reference lists and citations for relevant literature. We included studies published in English reporting risk of preeclampsia, spontaneous abortion and stillbirths, preterm birth, preterm prelabor rupture of membranes (PPROM) and adverse prenatal infectious diseases in women of refugee status. PROSPERO registration CRD42020205628. RESULTS: We identified 19 articles eligible for inclusion. Of the included articles twelve were cross-sectional, six were cohort studies and one was a case-control study. The most frequently reported outcome in the literature was preterm birth (reported in 16 of the studies) and preeclampsia (reported in 11 of the studies). Refugees had increased risk of stillbirth (reported relative risk ranging from 1.20 to 2.24) and spontaneous abortion (reported relative risk ranging from 1.56 to 1.58), when compared to native women and a decreased risk of preeclampsia (reported relative risk ranging from 0.65 to 0.81). CONCLUSIONS: A low number of articles eligible for inclusion in the review highlights the lack of research and knowledge on refugee's health during pregnancy. Further research is required to understand and reduce disparities in pregnancy outcomes between refugee and non-refugee women.