General Obstetrics and Gynecology: Obstetrics
Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state

https://doi.org/10.1016/j.ajog.2004.12.003Get rights and content

Objective

The purpose of this study was to compare maternal and neonatal morbidity among Somali immigrants, US-born blacks and whites in Washington state.

Study design

Washington state birth certificate data was linked to hospital discharge records comparing singleton deliveries among Somali immigrants with US-born blacks and whites between 1993 and 2001, in a 1:3 ratio. Outcomes were compared using unconditional multiple logistic regression models calculating odds ratios (ORs), and 95% confidence intervals (95% CIs).

Results

Five hundred seventy-nine pregnancies from Somali women were compared with 2384 and 2435 pregnancies from black and white women, respectively. Nulliparous Somali women were more likely to have a cesarean delivery than black or white control women, OR 1.6 (95% CI, 1.1-2.3) and 2.0 (95% CI, 1.4-2.8), respectively. Among all women who had cesarean deliveries, Somali women more commonly had cesarean deliveries associated with fetal distress and failed induction of labor. They were 9 times more likely than both control groups to deliver after 42 weeks gestation, and 4 times more likely than black women and 8 times more likely than white women to have oligohydramnios. Somali women were more likely to have gestational diabetes and significant perineal lacerations, and less likely to smoke. Newborns of Somali women were at increased risk for prolonged hospitalization, lower 5-minute Apgar scores, assisted ventilation, and meconium aspiration.

Conclusion

Pregnancy outcomes should be evaluated within ethnically and culturally unique groups; Somali immigrants are a high-risk subpopulation.

Section snippets

Material and methods

The Institutional Review Board of the University of Washington approved this population-based retrospective cohort study. The Birth Events Records Database (BERD), which links birth certificate data with the birth hospitalization discharge data for both the mother and child for all nonfederal hospitals in Washington state, was utilized. BERD contains information from the birth certificate about the pregnancy, delivery, infant status, demographic characteristics, and adverse maternal and

Results

Two hundred sixty-six Somali women, 151 US-born black women, and 86 US-born white women had more than 1 singleton birth during the study period and information from these 503 pregnancies were excluded from the analysis. After these exclusions, the cohort included 579 singleton births to Somali women, 2384 singleton births to US-born blacks, and 2453 singleton births to US-born whites.

Somali deliveries from 1993 to 2001 in Washington state were almost exclusively confined to urban areas in and

Comment

Pregnancy complications and obstetric and neonatal outcomes are usually described within the context of broad racial and ethnic categories: white, black, Asian, Native American and Pacific Islander.2 Our study underscores the importance of evaluating outcomes by ethnically and culturally unique groups. Our findings demonstrate a clear difference, and poorer outcomes, between women who were born in Somalia compared with US-born black or white women.

Others1 have compared perinatal complications

Acknowledgments

We appreciate the assistance of Bill O'Brian in the data preparation for statistical analysis; Beth Mueller in study design; and Michael Neufeld in reviewing neonatal outcome analysis.

References (12)

  • U. Larsen et al.

    Female circumcision and obstetric complications

    Int J Gynaecol Obstet

    (2002)
  • S. De Silva

    Obstetric sequelae of female circumcision

    Eur J Obstet Gynecol Reprod Biol

    (1989)
  • P. Wise

    The importance of extreme prematurity and low birthweight to US neonatal mortality patterns: implications for prenatal care and women's health

    J Am Med Womens Assoc

    (1995)
  • J. Chang et al.

    Reproductive health contents and maternal mortality: pregnancy-related mortality surveillance—United States,1991-1999

    MMWR

    (2003)
  • S. Vangen et al.

    Perinatal complications among ethnic Somalis in Norway

    Acta Obstet Gynecol Scan

    (2002)
  • L.Y. Hakim

    Impact of female genital mutilation on maternal and neonatal outcomes during parturition

    East Afr Med J

    (2001)
There are more references available in the full text version of this article.

Cited by (0)

Funding provided by Center of Excellence in Women's Health, DHHS grant no. 213-98-0016.

Reprints not available from the authors.

View full text