Hande İLERİ, Suna YILDIRIM KARACA, Ayşe Rabia ŞENKAYA, Alper İLERİ, Can ATA

Suriyeli mülteci ve türk kadınlarının perinatal eğilimleri ve obstetrik sonuçları

Amaç: Göçün sağlık üzerindeki etkisi geniş kapsamlıdır ve göçmen nüfusu özellikle savunmasız hale getirmekte, sağlık eşitsizliklerini körüklemekte ve küresel sağlık üzerinde ciddi sonuçlar doğurmaktadır. Çalışmamızın amacı, Türkiye’de yaşayan Suriye’den göç etmiş gebelerin doğum öncesi bakım, gebelik ve yenidoğan sonuçlarını değerlendirmektir. Gereç ve Yöntem: 2013-2019 yılları arasında doğum yapan Suriye’den göç etmiş ve Türkiye Cumhuriyeti (TC) vatandaşı gebeler, doğumdaki anne yaşlarına göre gruplara ayrıldı. Birinci trimester kombine testi, ikinci trimester üçlü testi, erken doğum, maternal anemi; ölü doğum, APGAR skorları, doğum ağırlığı ve emzirme durumu değerlendirildi. Bulgular: 4992 Suriye’den göç etmiş ve 6846 ve TC vatandaşı gebe dâhil edildi. Maternal anemi, TC vatandaşı gebelerde 20-34 ve ≥35 gruplarda daha yüksekti. İlk trimester kombine testi, APGAR skorları ve doğum ağırlıkları Suriye’den göç etmiş gebelerde daha düşüktü. Sadece 20-34 yaş grubundaki TC vatandaşı gebelerde preterm doğum oranları daha yüksekti. İkinci trimester üçlü testler sadece ≥35 yaş grubundaki TC vatandaşı kadınlarında daha yüksekti. Düşük doğum ağırlığı Suriyel’den göç eden genç gebelerde daha yüksekti. Suriye’den göç etmiş kadınlarda tatmin edici emzirme sonuçları bulundu. Sonuç: Çalışmamız, Suriye’den göç etmiş gebelerin adölesan ve 20-34 yaş gruplarında düşük doğum ağırlığı ve tüm yaş gruplarında ilk trimester kombine testte düşük oranlar açısından risk altında olduğunu gösterdi. Ancak Suriye’den göç etmiş gebelerde maternal anemi, erken doğum, sezaryen doğum ve tatmin edici emzirme sonuçları gibi gebelik komplikasyonları riskinde azalma bulundu.

Perinatal trends and birth outcomes of Syrian refugee and turkish women

Aim: The impact of migration on health is far-reaching, making migrant populations particularly vulnerable, fueling health inequalities and resulting in serious implications for global health. The aim of our study to assess antenatal care, pregnancy and neonatal outcomes of Syrian refugee women in Turkiye. Material and Methods: Syrian and Turkish pregnants who delivered between 2013-2019 were recruited and categorized into groups according to maternal age at delivery. First trimester combined test, second trimester triple test, preterm delivery, maternal anemia; neonatal stillbirth, APGAR scores, birth weight and breastfeeding status were assessed. Results: 4992 Syrian and 6846 Turkish pregnants were included. Maternal anemia was higher in Turkish patients in 20-34 and ≥35 groups. First trimester combined test, APGAR scores and birth weights were lower in Syrian women. Preterm rates higher in Turkish patients in only 20-34 age group. Second-trimester triplet tests were only higher in Turkish women in ≥35 age group. Low birth weight was higher in younger Syrian patients. Satisfying breastfeeding results were found in Syrian women. Conclusion: Our study stated that Syrian women are at risk of low birth weight in adolescent and 20-34 age groups and low rates in first trimester combined test in all age groups. However decreased risk of pregnancy complications such as maternal anemia, preterm delivery, cesarean delivery and satisfying breastfeeding results were found in Syrian patients.

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1. UNHCR (United Nations High Commissioneer for Refugees). Global Trends-Forced Displacement in 2016. December 2017.
2. WHO. Provision of effective antenatal care INTEGRATED MANAGEMENT OF PREGNANCY AND CHILDBIRTH (IMPAC) Standards. Int J Equity Health. 2006; 14 (1): 2.
http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/effective_antenatal_care.pdf%5Cnhttp://www.equityhealthj.com/content/14/1/2.
3. Weldemariam S, Damte A, Endris K, et al. Late antenatal care initiation: The case of public health centers in Ethiopia. BMC Res Notes. 2018; 11 (1): 1-6. doi:10.1186/s13104-018-3653-6
4. Khanlou N, Haque N, Skinner A, et al. Scoping Review on Maternal Health among Immigrant and Refugee Women in Canada: Prenatal, Intrapartum, and Postnatal Care. J Pregnancy. 2017; 2017. doi:10.1155/2017/8783294
5. World Health Organization. The health of youth, A42/technical discussion/2. 1989; (May). 6. Sauer M V. Reproduction at an advanced maternal age and maternal health. Fertil Steril. 2015; 103 (5): 1136-1143. doi:10.1016/j.fertnstert.2015.03.004
7. Dinçer OB, Federici V, Ferris E, et al. Turkiye and Syrian Refugees: The Limits of Hospitality. Brookings. 2013.
8. Abdin L. Challenges for pregnant syrian refugees in Lebanon. East Mediterr Heal J. 2018; 24 (10): 1026-1029. doi:10.26719/2018.24.10.1026
9. Gibson-helm M, Boyle J, Cheng I, et al. International Journal of Gynecology and Obstetrics Maternal health and pregnancy outcomes among women of refugee background from Asian countries. Int J Gynecol Obstet. 2015; 129 (2): 146-51. doi:10.1016/j.ijgo.2014.10.036
10. Kanmaz AG. Inan AH, Beyan E, et al. Obstetric Outcomes of Syrian Refugees and Turkish Citizens. Arch Iran Med 2019; 22 (September): 482-8.
11. Getachew M, Abay M, Zelalem H, et al. Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps , northern Ethiopia. BMC Pregnancy and Childbirth. 2018; 18: 83.
12. Sağlık Bakanlığı. Doğum Öncesi Bakım Yönetim Rehberi. 2014: 55.
13. World Health Organization (WHO). Appropriate Technology For Birth. Lancet. 1985; 2 (8452): 436-7.
14. İstatistikler T. Sağlık Göstergeleri Eylül / 2018. 2018.
15. Güngör ES, Seval O, İlhan G, et al. Do syrian refugees have increased risk for worser pregnancy outcomes? Results of a tertiary center in İstanbul. Turk Jinekoloji ve Obstet Dern Derg. 2018; 15 (1): 23-7. doi:10.4274/tjod.64022
16. Sørbye IK, Wanigaratne S, Urquia ML. Best Practice & Research Clinical Obstetrics and Gynaecology Variations in gestational length and preterm delivery by race, ethnicity and migration. Best Pract Res Clin Obstet Gynaecol. 2015:1-9. doi:10.1016/j.bpobgyn.2015.08.017
17. Juárez S, Mussino E, Hjern A. Being a refugee or having a refugee status ? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden. 2018; (April): 1-5. doi:10.1177/1403494818777432
18. Spallek J, Lehnhardt J, Reeske A, et al. Perinatal outcomes of immigrant women of Turkish, Middle Eastern and North African origin in Berlin, Germany : a comparison of two time periods. Arch Gynecol Obstet 2013. doi:10.1007/s00404-013-2986-6
19. Demirci H, Yildirim Topak N, Ocakoglu G, et al. Birth characteristics of Syrian refugees and Turkish citizens in Turkiye in 2015. Int J Gynecol Obstet. 2017; 137 (1): 63-6. doi:10.1002/ijgo.12088
20. Gissler M, Alexander S, Macfarlane A. Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstetricia et Gynecologica 2009; 88: 134-48 doi:10.1080/00016340802603805
21. Stewart DE. et al. Risk Factors and Health Profiles of Recent Migrant Women Who Experienced Violence Associated with Pregnancy. Journal of Women Health. 2012; 21 (10): 1100-6. doi:10.1089/jwh.2011.3415
22. Urquia ML, Frank JW, Glazier RH, et al. Neighborhood context and infant birthweight among recent immigrant mothers: A multilevel analysis. Am J Public Health. 2009; 99 (2): 285-93. doi:10.2105/AJPH.2007.127498
23. Ozel S, Yaman S, Kansu-Celik H, et al. Obstetric Outcomes among Syrian Refugees: A Comparative Study at a Tertiary Care Maternity Hospital in Turkiye. Rev Bras Ginecol e Obstet. 2018; 40 (11): 673-9. doi:10.1055/s-0038-1673427
24. Ray JG, Sgro M, Mamdani MM, et al. Birth Weight Curves Tailored to Maternal World Region. J Obstet Gynaecol Canada. 2012; 34 (2): 159-71. doi:10.1016/S1701-2163 (16) 35159-3
25. Vangen S, Stoltenberg C, Johansen REB, et al. Perinatal complications among ethnic Somalis in Norway. Acta Obstet Gynecol Scand. 2002; 81 (5): 317-22.
26. Landale NS, Gorman BK, Oropesa RS. Selective migration and infant mortality among Puerto Ricans. Matern Child Health J. 2006; 10 (4): 351-60. doi:10.1007/s10995-006-0072-4
27. Griffiths LJ, Tate AR, Dezateux C, et al. Do early infant feeding practices vary by maternal ethnic group? Public Health Nutr. 2007; 10 (9): 957-64. doi:10.1017/S1368980007665513
28. Groleau D, Soulière M, Kirmayer LJ. Breastfeeding and the cultural configuration of social space among Vietnamese immigrant woman. Heal Place. 2006; 12 (4): 516-26. doi:10.1016/j.healthplace.2005.08.003
29. Schmied V, Olley H, Burns E, Duff M, Dennis C, Dahlen HG. Contradictions and conflict : A meta-ethnographic study of migrant women ’ s experiences of breastfeeding in a new country. BMC Pregnancy Childbirth. 2012; 12 (1): 1. doi:10.1186/1471-2393-12-163.