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

Abstract

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.

Keywords: Emergency cesarean section; Immigrants; Postpartum hemorrhage; Pregnancy outcome; Vacuum extraction.