背景:与接收国的妇女相比,移民妇女是一个异质性群体,其妊娠并发症和不良分娩结局的风险较高和较低。本研究旨在调查妇女产后使用瑞典医疗保健的情况,住院时间>48小时,再次入院,和专门的门诊就诊,关于母亲的出生国。
方法:一项基于人群的登记研究,包括瑞典278219名初产妇和367776名多胎妇女(2014-2019年),使用瑞典妊娠登记册的数据,瑞典国家患者登记和统计。多变量逻辑回归分析用于估计产妇出生国和结局之间的关联,调整出生年份,产妇年龄,教育,孕前高血压和糖尿病,和医疗保健地区,以瑞典出生女性为参考,以95%置信区间(CI)表示为粗比值比和调整后比值比(aOR)。
结果:移民妇女亚组产后住院时间>48小时的几率更高,尤其是来自厄立特里亚的妇女(初产AOR2.80,CI2.49-3.15;多产AOR2.78,CI2.59-2.98),索马里(初产aOR2.61,CI2.34-2.92;多产aOR1.87,CI1.79-1.97),和印度(初产AOR2.52,CI2.14-2.97;多产AOR2.61,CI2.33-2.93),与瑞典出生的女性相比。来自阿富汗的初产妇(aOR1.32,CI1.08-1.6),伊拉克(aOR1.30,CI1.16-1.46),伊朗(aOR1.23,CI1.04-1.45)再次入院的几率略高,以及来自印度(aOR1.34,CI1.02-1.76)和索马里(aOR1.24,CI1.11-1.38)的多产妇女。专业门诊就诊最常见于索马里初产妇(aOR1.47,CI1.35-1.59),伊朗(aOR1.31,CI1.22-1.42)和阿富汗(aOR1.31,CI1.18-1.46),在伊朗(aOR1.30,CI1.20-1.41)和伊拉克(aOR1.15,CI1.11-1.20)的多产妇女中,然而在其他一些国家的女性中却不那么常见。
结论:妇女在产后期间瑞典医疗保健的使用各不相同,这取决于他们的出生国家。来自某些国家的妇女产后住院时间超过48小时的几率特别高,与瑞典出生的女性相比,不管胎次和孕前医学疾病。需要进一步的研究来确定在产后期间移民妇女的个人需求是否得到满足。
BACKGROUND: Migrant women are a heterogenous group with both higher and lower risk for pregnancy complications and adverse birth outcomes compared with women in the receiving countries. This study aimed to investigate women\'s use of Swedish healthcare postpartum, in terms of hospital stay >48 h, readmission to hospital, and specialized out-patient clinic visits, in relation to maternal country of birth.
METHODS: A population-based register study including 278 219 primiparous and 367 776 multiparous women in Sweden (2014-2019) using data from Swedish Pregnancy Register, National Patient Register and Statistics Sweden. Multivariable logistic regression analyses were used to estimate associations between maternal country of birth and outcomes, adjusting for year of birth, maternal age, education, pre-gestational hypertension and diabetes, and healthcare region, presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI) with Swedish-born women as reference.
RESULTS: Subgroups of migrant women had higher odds of postpartum hospital stays > 48 h, particularly women from Eritrea (primiparous aOR 2.80, CI 2.49-3.15; multiparous aOR 2.78, CI 2.59-2.98), Somalia (primiparous aOR 2.61, CI 2.34-2.92; multiparous aOR 1.87, CI 1.79-1.97), and India (primiparous aOR 2.52, CI 2.14-2.97; multiparous aOR 2.61, CI 2.33-2.93), compared to Swedish-born women. Primiparous women from Afghanistan (aOR 1.32, CI 1.08-1.6), Iraq (aOR 1.30, CI 1.16-1.46), and Iran (aOR 1.23, CI 1.04-1.45) had slightly higher odds of hospital readmission, along with multiparous women from India (aOR 1.34, CI 1.02-1.76) and Somalia (aOR 1.24, CI 1.11-1.38). Specialized out-patient clinic visits were most common in primiparous women from Somalia (aOR 1.47, CI 1.35-1.59), Iran (aOR 1.31, CI 1.22-1.42) and Afghanistan (aOR 1.31, CI 1.18-1.46), and in multiparous women from Iran (aOR 1.30, CI 1.20-1.41) and Iraq (aOR 1.15, CI 1.11-1.20), however less common in women from some other countries.
CONCLUSIONS: The use of Swedish health care during the postpartum period varied among women, depending on their country of birth. Women from certain countries had particularly high odds of postpartum hospital stays exceeding 48 h, compared to Swedish-born women, regardless of parity and pre-gestational medical disorders. Further studies are needed to determine whether the individual needs of migrant women are being met during the postpartum period or not.