Perinatal complications among ethnic Somalis in Norway

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Abstract

The majority of ethnic Somali women in Norway have undergone an elaborate form of circumcision (infibulation). The aim of this study was to examine the risk of perinatal complications among ethnic Somalis and to discuss its relation to circumcision. We conducted a cross-sectional population-based registry study. Data on all births to women born in Somalia (1733) and Norway (702 192) from 1986 to 1998 was provided from the Medical Birth Registry of Norway. We analyzed the risk of perinatal complications among women of Somali origin vs. ethnic Norwegians using univariate and multivariate methods. Perinatal complications were more frequent among women of Somali origin than among ethnic Norwegians. These included induction of labor, fetal distress, secondary arrest, prolonged second stage of labor, operative delivery and perinatal death. Particularly elevated odds ratios were found for fetal distress (odds ratio=2.6, 95% confidence interval (CI); 2.2-3.0), emergency cesarean sections (odds ratio=3.0, 95% confidence interval 2.6-3.4), Apgar scores below seven (odds ratio = 3.1, 95% confidence interval 2.4-4.0) and prelabor fetal deaths (odds ratio=2.5, 95% confidence interval 1.7-3.7). Similar findings in infibulated vs. noncircumcised women have been demonstrated previously in other studies indicating that circumcision could play a role. The current study is the first to be conducted among Somali women in Europe. However, the results are not informative on whether the adverse birth outcomes are caused by infibulation as such or in combination with suboptimal perinatal care, intercurrent diseases and sociocultural factors. Somali women represent a high-risk group in obstetrics, calling for special attention and care.

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Fear of childbirth during pregnancy may increase the risk of emergency cesarean section.

H Rydhström, E Ryding, B Wijma … (1998)

The purpose of our study was to elucidate the association between fear of childbirth, general anxiety, and stress coping during the third trimester of pregnancy, and a subsequent delivery by emergency cesarean section. In a case-control study, 1,981 Swedish-speaking women completed three self-assessment questionnaires at 32 weeks' gestation. Ninety-seven of these women were delivered by emergency cesarean section. Fear of childbirth, general anxiety and the stress coping ability of these 97 cases were compared with the same features in 194 controls, matched for age and parity. Women, subsequently delivered by emergency cesarean section, reported a greater anxiety and a poorer stress coping ability, and, most obviously, a greater fear of childbirth at 32 weeks' gestation. After elimination of possible confounders, the odds ratio for emergency cesarean section was examined for women whose scores were above various cut-off points according to the fear of childbirth measuring instrument. For women with a serious fear of childbirth the odds ratio was 3.0 (95% confidence interval 1.4 to 6.6), and the population attributable risk 0.167. Fear of childbirth during the third trimester of pregnancy may increase the risk of subsequent emergency cesarean section.

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Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden.

BIRGITTA ESSÉN, BERTIL HANSON, PER-OLOF ÖSTERGREN … (2000)

The aim of the study was to investigate whether the maternal country of origin affected the risk for perinatal mortality and to determine its relationship to risk factors. A study of 15,639 deliveries in Malmö, Sweden. Data regarding demographic factors, life-style and perinatal risk factors, together with data pertaining to outcome was obtained from the Malmö database and the Swedish Medical Birth Register. Perinatal mortality was increased among infants to women of Foreign origin as compared to those delivered by women of Swedish origin (OR 1.5, CI 1.0-2.2). Even after adjustments for maternal background and risk factors (diabetes, anemia, pre-eclampsia, placental abruption and small-for-gestational age), the increased risk of perinatal mortality among women of Foreign origin remained statistically significant. Women from sub-Saharan Africa, comprising 7.3% of all immigrants, differed from all other subgroups of women of foreign origin by having a higher risk of adverse outcome (small-for-gestational age OR 1.9, CI 1.0-3.6, neonatal distress OR 2.7, CI 5.1-4.8 and perinatal mortality OR 4.3, CI 2.1-8.6). Women of foreign origin, especially from sub-Saharan Africa, have a higher risk of perinatal mortality than native Swedish women. The differences in mortality could not be explained by risk factors. The results suggest that women and newborns from sub-Saharan Africa should be given more intense surveillance on all levels of perinatal care in order to reduce perinatal mortality.