Health of Pregnant Migrant Women and their Newborns in Finland

Kalpana Bastola

Research output: Book/ReportDoctoral thesisCollection of Articles

Abstract

The general aim of this dissertation was to examine the health of pregnant migrant women and their newborns in Finland. To accomplish the aim, four studies were conducted (papers I–IV) in total. The objectives of this thesis were to study mean pre-pregnancy body mass index and inter-pregnancy weight change (paper I); prevalence of pregnancy complications, mainly gestational diabetes and hypertensive disorders (paper II); mode of delivery; and prevalence of delivery complications (paper III) among women of Russian, Somali and Kurdish origin as well as the general Finnish population. Paper IV studied differences in the prevalence of elective and emergency caesarean delivery and neonatal outcomes, mainly preterm birth, low birthweight, Apgar score and admission in the neonatal intensive care unit between all women of migrant origin and Finnish women in Finland.

The data for the first three papers were based on a sample of migrant women of Russian, Somali and Kurdish origin. These groups were identified from the Population Register of the Migrant Health and Wellbeing Survey. The sample of the reference group, women in the general population, were identified from the nationallevel Health 2011 Survey. Their data were extracted from the Finnish Medical Birth Register (MBR), Statistics Finland and the Care Register for Health Care. In total, 318 Russian, 583 Somali, 373 Kurdish and 243 women from the general population and data on their most recent singleton birth in Finland, between years 2004–2014, were included in papers I–III. The main method of analysis was linear regression for paper I and logistic regression for papers II and III, adjusted for confounders.

The data for paper IV was based on nationwide data from MBR and Statistics Finland. Paper IV included data on the most recent singleton delivery of all women who gave birth in Finland between years 2004–2014 (N=382,233). Women were classified into nine regional categories based on their country of origin. Generalised linear models were used to examine associations between the country of origin and mode of delivery or neonatal outcomes, adjusted for confounders. Finnish women were the reference group.

In paper I, the mean pre-pregnancy BMI was lower in Russian women (adjusted coefficients −1.93, 95% CI −2.77 to −1.09), and higher in Somali (adjusted coefficients 1.82, 95% CI 0.89–2.75) and Kurdish women (adjusted coefficients 1.30, 95% CI 0.43 to 2.17) compared with women in the general population. No statistically significant differences were observed in the mean inter-pregnancy weight change between the Russian, Somali and Kurdish women compared with women in the general population. Paper II reported that Kurdish women had higher odds for gestational diabetes mellitus (adjusted OR 1.98, 95% CI; 1.20 to 3.32) compared with the general population, but the odds for hypertensive disorders did not differ between the migrant groups and women in the general population. In paper III, Russian women had lower odds (adjusted OR 0.49, 95% CI 0.29 to 0.82) of having a caesarean delivery, whereas Somali and Kurdish women did not differ from the reference group. Somali women had an increased risk of any delivery complications (adjusted OR 1.62, 95% CI 1.03 to 2.55) compared with women in the general population. Furthermore, no differences were observed in the use of pain medication between the groups.

Paper IV reported that, compared with Finnish women, Sub-Saharan African women had higher risks for emergency caesarean delivery (adjusted RR 2.98, 95% CI 2.70 to 3.29), preterm births (adjusted RR 1.21, 95% CI 1.03 to 1.42), low birthweight (adjusted RR 1.99, 95% CI 1.60 to 2.33), lower 5-minute Apgar score (adjusted RR 2.59, 95% CI 2.18 to 3.08) and intensive care unit care (adjusted RR 1.36, 95% CI 1.23 to1.51) for newborns. South Asian and East Asian women were at an increased risk for emergency caesarean delivery (adjusted RR 2.17, 95% CI 1.91 to 2.46; adjusted RR 1.41, 95% CI 1.28 to 1.54, respectively), preterm birth (adjusted RR 1.45, 95% CI 1.19 to 1.77; adjusted RR 1.28, 95% CI 1.13 to 1.46, respectively), low birthweight (adjusted RR 2.43, 95% CI 2.08 to 2.94; adjusted RR 1.25, 95% CI 1.08 to 1.46, respectively) and lower 5-minute Apgar score (adjusted RR 2.06, 95% CI 1.55 to 2.76; adjusted RR 1.36, 95% CI 1.11 to 1.67, respectively) compared with Finnish women. Latin America/Caribbean women had higher risks for both elective and emergency caesarean delivery (adjusted RR 1.46, 95% CI 1.14 to1.87; adjusted RR 1.74, 95% CI 1.41 to 2.15, respectively) and lower 5-minute Apgar score (adjusted RR 1.95, 95% CI 1.30 to 2.91) compared with Finnish women.

In conclusion, this study contributed to evidence on differences in pre-pregnancy BMI, prevalence of pregnancy and delivery complications, caesarean delivery and neonatal outcomes among women of migrant origin and Finnish women in Finland. More research is needed to better understand the reasons and mechanisms behind these differences and to develop interventions for improving the health outcomes among the higher-risk groups.
Original languageEnglish
Place of PublicationTampere
PublisherTampere University
ISBN (Electronic)978-952-03-1565-8
ISBN (Print)978-952-03-1564-1
Publication statusPublished - 2020
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
Volume254
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028

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