背景:世界卫生组织(WHO)建议在妊娠12周前开始产前护理(ANC),以降低产科和围产期并发症的风险。移民,难民,寻求庇护者迟发或不启动ANC的风险更高,被排除在全民医疗保健(UHC)之外可能是一个促成因素。
目的:目的是综合有关摄入ANC的证据,并检查这是否与UHC的获取不足有关,并评估ANC与移民妊娠结局风险之间的联系,难民和寻求庇护者。
方法:根据流行病学观察性研究(MOOSE)指南的荟萃分析进行综述。系统地检索了5个数据库。根据纳入标准筛选摘要,符合条件的论文由每篇论文的两名独立审稿人进行数据提取。ROBINS-I工具用于评估偏倚风险。
结果:12项研究纳入最终综述。所有研究都报告说,ANC被列为移民的女性被推迟,难民,根据世界卫生组织的建议和寻求庇护者,12项研究中有11项与对照组相比具有统计学意义(P<0.05)。关于ANC摄取和妊娠并发症的发现过于异质,无法最终报告其相关性。
结论:移民,被排除在UHC之外的难民和寻求庇护者在ANC出现的时间明显晚于接受国家出生的妇女,可以完全使用UHC。由于研究的异质性,由于UHC通路不足而导致的延迟ANC与妊娠并发症之间的联系尚不清楚。
BACKGROUND: The World Health Organization (WHO) recommends that antenatal care (ANC) commence before 12 weeks\' gestation to reduce the risk of obstetric and perinatal complications. Immigrants, refugees, and asylum seekers are at higher risk for late or non-initiation of ANC, and exclusion from universal healthcare (UHC) may be a contributing factor.
OBJECTIVE: The aims were to synthesise evidence regarding uptake of ANC and to examine if this is associated with inadequate access to UHC and to evaluate the link between ANC and the risk of pregnancy outcomes in the immigrant, refugee and asylum seeker population.
METHODS: The
review was performed according to meta-analysis of observational studies in epidemiology (MOOSE) guidelines. Five databases were systematically searched. Abstracts were screened against inclusion criteria, and eligible papers underwent data extraction by two independent reviewers per paper. The ROBINS-I tool was used to assess risk of bias.
RESULTS: Twelve studies were included in the final
review. All studies reported that ANC was delayed for women who were classified as immigrants, refugees, and asylum seekers as per the WHO recommendations, and this was statistically significant compared to controls in 11 of 12 studies (P < 0.05). Findings regarding ANC uptake and pregnancy complications were too heterogeneous to conclusively report an association.
CONCLUSIONS: Immigrants, refugees and asylum seekers who are excluded from UHC present significantly later to ANC than receiving-country-born women with full access to UHC. The link between delayed ANC due to inadequate UHC access and pregnancy complications remains unclear due to the heterogeneous nature of the studies.