Risk of Subsequent Preeclampsia by Maternal Country of Birth: A Norwegian Population-Based Study.

In this nationwide population-based study, we investigated the associations of preeclampsia in the first pregnancy with the risk of preeclampsia in the second pregnancy, by maternal country of birth using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study population included 101,066 immigrant and 544,071 non-immigrant women. Maternal country of birth was categorized according to the seven super-regions of the Global Burden of Disease study (GBD). The associations between preeclampsia in the first pregnancy with preeclampsia in the second pregnancy were estimated using log-binomial regression models, using no preeclampsia in the first pregnancy as the reference. The associations were reported as adjusted risk ratios (RR) with 95% confidence intervals (CI), adjusted for chronic hypertension, year of first childbirth, and maternal age at first birth. Compared to those without preeclampsia in the first pregnancy, women with preeclampsia in the first pregnancy were associated with a considerably increased risk of preeclampsia in the second pregnancy in both immigrant (n = 250; 13.4% vs. 1.0%; adjusted RR 12.9 [95% CI: 11.2, 14.9]) and non-immigrant women (n = 2876; 14.6% vs. 1.5%; adjusted RR 9.5 [95% CI: 9.1, 10.0]). Immigrant women from Latin America and the Caribbean appeared to have the highest adjusted RR, followed by immigrant women from North Africa and the Middle East. A likelihood ratio test showed that the variation in adjusted RR across all immigrant and non-immigrant groups was statistically significant (p = 0.006). Our results suggest that the association between preeclampsia in the first pregnancy and preeclampsia in the second pregnancy might be increased in some groups of immigrant women compared with non-immigrant women in Norway.

Pelvic Floor Disorders and Pelvic Floor Muscle Exercise: A Survey on Knowledge, Attitude, and Practice among Pregnant Women in Northwest Ethiopia.

The purpose of the study was to investigate 1: overall knowledge of pelvic organ prolapse (POP) and urinary incontinence (UI) as well as knowledge, attitudes, and practice of pelvic floor muscle exercise (PFME); and 2: the association of these factors with parity in pregnant women in Gondar, Ethiopia. A facility-based cross-sectional study was performed in the Central Gondar zone, northwest Ethiopia between February and April 2021. The associations between parity and knowledge of POP and UI, and knowledge, attitude, and practice towards PFME were estimated using logistics regression models and presented as crude and adjusted odds ratios with 95% confidence intervals. Nulliparous women were used as the reference. Adjustments were made for maternal age, antenatal care visits, and level of education. The study sample comprised 502 pregnant women: 133 nulliparous, and 369 multiparous. We found no association between parity and knowledge of POP, UI, or knowledge, attitude, and practice toward PFME. The sum score indicated poor knowledge about both POP, UI, and PFME in the study population, and poor attitude and practice of PFME. Despite a high attendance in antenatal care services, knowledge, attitude, and practice were poor, indicating a need for quality improvement of the services.

Prenatal health of immigrant women in Norway - an exploratory literature review. / Helse i svangerskapet blant innvandrerkvinner i Norge ­ en utforskende litteraturoversikt.

BACKGROUND: Immigrant women are a vulnerable group within Norwegian prenatal care and have an increased risk of adverse pregnancy outcomes. The purpose of this exploratory literature review was to compile an overview of the available knowledge on the prenatal health of immigrant women in Norway. EVIDENCE BASE: The literature review covers 44 peer-reviewed articles on the prenatal health of immigrant women in Norway. The articles reflect a variety of study designs and were published in the period 2000-2019. Searches were conducted in MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Maternity & Infant Care Database and SveMed+. RESULTS: Frequently studied topics included gestational diabetes, obesity, hyperemesis gravidarum, preeclampsia and folate use. We found a considerable variation in the disease risk for different sub-groups of immigrants. INTERPRETATION: Little research has been conducted on especially vulnerable immigrant groups, such as new arrivals, undocumented immigrants and refugees. We recommend that future studies consider using a qualitative research design that sheds light on the experiences of immigrant families, as well as intervention studies that test the effectiveness of measures for improving prenatal care.

Placental abruption in immigrant women in Norway: A population-based study.

INTRODUCTION: Placental abruption is a serious complication in pregnancy. Its incidence varies across countries, but the information of how placental abruption varies in immigrant populations is limited. The aims of this study were to estimate the incidence of placental abruption in immigrant women compared with non-immigrants by maternal country and region of birth, reason for immigration, and length of residence. MATERIAL AND METHODS: We conducted a nationwide population-based study using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study sample included 1 558 174 pregnancies, in which immigrant women accounted for 245 887 pregnancies and 1 312 287 pregnancies were to non-immigrants. Crude and adjusted odds ratios with 95% CI for placental abruption in immigrant women compared with non-immigrants were estimated by logistic regression with robust standard error estimations (accounting for within-mother clustering). Adjustment variables included year of birth, maternal age, parity, multiple pregnancies, chronic hypertension, and level of education. RESULTS: The incidence of placental abruption decreased during the study period for both immigrants (from 0.68% to 0.44%) and non-immigrants (from 0.80% to 0.34%). Immigrant women from sub-Saharan Africa had an adjusted odds ratio of 1.35 (95% CI 1.15-1.58) compared with non-immigrants for placental abruption, whereas immigrant women from Ethiopia had an adjusted odds ratio of 2.39 (95% CI 1.67-3.41). We found a small variation in placental abruption incidence by other countries or regions of birth, length of residence, and reason for immigration. CONCLUSIONS: Immigrant women from sub-Saharan Africa, especially Ethiopia, have increased odds for placental abruption when giving birth in Norway. Reason for immigration and length of residence had little impact on the incidence of placental abruption.

Risk for delivery complications in Robson Group 1 for non-Western women in Norway compared with ethnic Norwegian women - A population-based observational cohort study.

OBJECTIVES: To assess the pregnancy outcome of low-risk pregnancies for women originating from non-Western countries compared with ethnic Norwegian women. STUDY DESIGN: A retrospective population-based observational cohort study with prospectively registered data. Conducted at Stavanger University Hospital, Norway, with approximately 4800 deliveries annually, from 2009 to 2015. We included women with low-risk pregnancies of non-Western origin (n = 1413), born in Africa (n = 224), Asia (n = 439), Eastern Europe (n = 499), Middle East (n = 138), South America (n = 85), Western (n = 979), and ethnic Norwegian women (n = 7028). MAIN OUTCOME MEASURES: The relative risk of emergency cesarean section or postpartum hemorrhage by country of origin was estimated by odds ratios with 95% confidence intervals using logistic multiple regression. RESULTS: In total, the pregnancy outcomes of 9392 women were analyzed. Risk of emergency cesarean section was significantly higher for women originating from Asia (aOR: 1.887), followed by Africans (aOR: 1.705). Lowest risk was found in women originating from South America (aOR: 0.480). Risk of postpartum hemorrhage was significantly higher in women originating from Asia (aOR: 1.744) compared to Norwegians. CONCLUSION: Even in a low-risk population, women originating from Asia and Africa had an elevated risk of adverse pregnancy outcome compared to the Norwegian group. The elevated risk should be considered by obstetric care providers, and we suggest that women originating from Asia and Africa would benefit from a targeted care during pregnancy and childbirth.