Severe acute maternal morbidity in asylum seekers: A two-year nationwide cohort study in the Netherlands

Objective. Asylum seekers often have poorer physical and mental health compared with the general population. The aim of this study was to assess incidence and risk indicators for severe acute maternal morbidity (SAMM) in asylum seekers. Design. Prospective, population-based cohort study. Setting. All 98 maternity units in the Netherlands. Population. All asylum seekers in the Netherlands. Methods. All cases of severe maternal morbidity in asylum seekers were collected during a two-year period. All pregnant women in the Netherlands in the same period acted as a reference cohort (n=371 021). Main Outcome Measures. Incidence and possible risk indicators of SAMM in asylum seekers. Results. Of the SAMM cases, 40 were identified as asylum seekers. This yields an incidence of 31 per 1 000 severe maternal morbidity in asylum seekers. Compared with the general Dutch population, asylum seekers have a four- to fivefold increased risk of SAMM (relative risk 4.5; 95% confidence interval 3.3-6.1). Even compared with other non-Western immigrant women, asylum seekers have an increased risk of SAMM (relative risk 3.6; 95% confidence interval 2.6-5.0). Possible risk indicators for SAMM are as follows: a single household, unemployment, low socio-economic status, major language barrier, short stay in the Netherlands, HIV positive, late gestational booking, multiparity and prior cesarean section. Conclusions. Asylum seekers have an increased risk for SAMM compared with other immigrant women, as well as compared with the general Dutch pregnant population. In this study, we identified possible additional risk factors. Special attention is needed while taking care of asylum-seeking pregnant women.