Health of Pregnant Migrant Women and their Newborns in Finland

Tämän väitöskirjan yleisenä tavoitteena oli tutkia raskaana olevien maahanmuuttajanaisten ja heidän vastasyntyneiden lastensa terveyttä Suomessa. Tutkimukseen kuuluu neljä osatyötä (Artikkelit I-IV). Tutkimuksen tavoitteina oli tutkia raskautta edeltävää keskimääräistä kehon painoindeksiä ja raskauksien välistä painonmuutosta (Artikkeli I), raskauskomplikaatioiden kuten raskausdiabeteksen ja verenpainetautien yleisyyttä (Artikkeli II), ja synnytystapaa ja synnytyskomplikaatioiden yleisyyttä (Artikkeli III) venäläis-, somalialais- ja kurditaustaisilla naisilla ja suomalaisilla naisilla. Artikkelissa IV tutkittiin eroja suunnitellun ja hätäkeisarileikkauksen yleisyydessä ja vastasyntyneeseen lapseen liittyvien vasteiden yleisyydessä (ennenaikaisen syntymä, pienipainoisuus, Apgarin pisteet ja vastasyntyneen tehohoito) kaikkien maahanmuuttajataustaisten ja suomalaistaustaisten naisten välillä Suomessa. Kolmen ensimmäisen osatyön aineisto perustui otokseen venäläis-, somalialaisja kurditaustaisista naisista. Nämä naiset tunnistettiin väestörekisteristä Maahanmuuttajien terveys ja hyvinvointi -tutkimusta varten. Vertailuotoksen suomalaiseen väestöön kuuluvat naiset otettiin kansallisesta Terveys 2011 tutkimuksesta. Heidän tietonsa saatiin Terveyden ja hyvinvoinnin laitoksen (THL) syntyneiden lasten rekisteristä ja hoitoilmoitusrekisteristä sekä Tilastokeskuksesta. Artikkeleihin I-III otettiin mukaan yhteensä 318 venäläis-, 583 somalialais- ja 373 kurditaustaista naista sekä 243 suomalaiseen väestöön kuuluvaa naista ja tiedot heidän viimeisimmästä yhden lapsen synnytyksestä vuosien 2004 ja 2014 välillä. Lineaarinen regressioanalyysi oli tärkein analyysimenetelmä Artikkelissa I ja logistinen regressioanalyysi artikkeleissa II ja III. Sekoittavia tekijöitä vakioitiin analyyseissä. Artikkelin IV aineisto perustui koko maan kattavaan aineistoon THL:n syntyneiden lasten rekisteristä ja Tilastokeskuksen taustatiedoista. Artikkeliin IV otettiin mukaan kaikilta Suomessa vuosina 2004-2014 synnyttäneiltä naisilta tiedot viimeisimmästä yhden lapsen synnytyksestä (n=382,233). Naiset luokiteltiin yhdeksään alueelliseen luokkaan alkuperämaan perusteella. Alkuperämaan ja synnytystavan tai vastasyntyneen lapsen vasteiden välisiä yhteyksiä tutkittiin yleistetyillä lineaarisilla malleilla, sekoittavat tekijät vakioiden. Suomalaiset naiset olivat vertailuryhmänä. Artikkelin I tulosten mukaan raskautta edeltävä painoindeksi oli pienempi venäläistaustaisilla (vakioitu kerroin -1,93, 95 % luottamusväli (lv) -2,77; -1,09) ja suurempi somalialaistaustaisilla (vakioitu kerroin 1,82, 95 % lv 0,89; 2,75) ja kurditaustaisilla (vakioitu kerroin 1,3, 95 % lv 0.43; 2,17) naisilla suomalaisväestöön nähden. Raskauksien välisessä painonmuutoksessa ei havaittu tilastollisesti merkitseviä eroja venäläis-, somalialais- ja kurditaustaisten naisten ja suomalaisten naisten välillä. Artikkelin II tulosten mukaan raskausdiabetes oli yleisempää kurditaustaisilla naisilla suomalaisiin naisiin verrattaessa (vakioitu vetosuhde, OR 1,98, 95 % lv 1,20; 3,32), mutta verenpainetautien yleisyydessä ei ollut eroa maahanmuuttajaryhmien ja suomalaisten naisten välillä. Artikkelissa III havaittiin, että keisarileikkaukset olivat harvinaisempia venäläistaustaisilla naisilla (vakioitu OR 0,49, 95 % lv 0,29; 0,82), mutta somalialais- ja kurditaustaisten ja suomalaisten naisten välillä ei havaittu eroa. Synnytyskomplikaatiot olivat yleisempiä somalialaistaustaisilla naisilla (vakioitu OR 1.62, 95 % lv 1,03; 2,55) kuin suomalaisilla naisilla. Ryhmien välillä ei ollut eroa kipulääkityksen käytössä. Artikkelin IV tulokset osoittivat, että Saharan eteläpuolisesta Afrikasta kotoisin olevilla oli suurempi hätäkeisarileikkauksen (vakioitu RR 2,98, 95 % lv 2,70; 3,29), ennenaikaisen synnytyksen (vakioitu RR 1,21, 95 % lv 1,03; 1,42), pienipainoisuuden (vakioitu RR 1,99, 95 % lv 1,60; 2,33), matalampien 5 minuutin Apgar-pisteiden (vakioitu RR 2,59, 95 % lv 2,18; 3,08) ja vastasyntyneen tehohoidon riski (vakioitu RR 1,36, 95 % lv 1,23; 1,51). Etelä-Aasiasta ja Itä-Aasiasta kotoisin olevilla oli suurempi hätäkeisarileikkauksen (vakioidut RR:t 2,17, 95 % lv 1,91; 2,46 ja 1,41, 95 % lv 1,28; 1,54), ennenaikaisuuden (vakioidut RR:t 1,45, 95 % lv 1,19; 1,77 ja 1,28, 95 % lv 1,13; 1,46), pienipainoisuuden (vakioidut RR:t 2,43, 95 % lv 2,08; 2,94 ja 1,25, 95 % lv 1,08; 1,46,) ja matalampien 5 minuutin Apgar-pisteiden riski (vakioidut RR:t 2,06, 95 % lv 1,55; 2,76 ja 1,36, 95 % lv 1,11; 1,67) suomalaistaustaisiin synnyttäjien nähden. Etelä-Amerikasta tai Karibialta kotoisin olevilla oli suurempi riski sekä suunnitellulle että hätäkeisarileikkaukselle (vakioidut RR:t 1,46, 95 % lv 1,14; 1,87 ja 1,74, 95 % lv 1,41; 2,15) ja matalammille 5 minuutin Apgar pisteille (vakioitu RR 1.95, 95 % lv 1.30; 2,91) suomalaisiin vertaillessa. Johtopäätöksenä voidaan todeta, että tämä tutkimus tuo uutta tietoa raskautta edeltävästä painoindeksistä ja raskaus- ja synnytyskomplikaatioiden, keisarileikkausten ja vastasyntyneen lapsen vasteiden yleisyydestä Suomessa asuvilla maahanmuuttajataustaisilla naisilla. Tarvitaan lisää tutkimusta, jotta voidaan ymmärtää paremmin näiden erojen taustalla olevia syitä ja mekanismeja sekä kehittää interventioita riskiryhmien terveyden parantamiseen.The general aim of this dissertation was to examine the health of pregnant migrant women and their newborns in Finland. To accomplish the aim, four studies were conducted (papers I–IV) in total. The objectives of this thesis were to study mean pre-pregnancy body mass index and inter-pregnancy weight change (paper I); prevalence of pregnancy complications, mainly gestational diabetes and hypertensive disorders (paper II); mode of delivery; and prevalence of delivery complications (paper III) among women of Russian, Somali and Kurdish origin as well as the general Finnish population. Paper IV studied differences in the prevalence of elective and emergency caesarean delivery and neonatal outcomes, mainly preterm birth, low birthweight, Apgar score and admission in the neonatal intensive care unit between all women of migrant origin and Finnish women in Finland. The data for the first three papers were based on a sample of migrant women of Russian, Somali and Kurdish origin. These groups were identified from the Population Register of the Migrant Health and Wellbeing Survey. The sample of the reference group, women in the general population, were identified from the nationallevel Health 2011 Survey. Their data were extracted from the Finnish Medical Birth Register (MBR), Statistics Finland and the Care Register for Health Care. In total, 318 Russian, 583 Somali, 373 Kurdish and 243 women from the general population and data on their most recent singleton birth in Finland, between years 2004–2014, were included in papers I–III. The main method of analysis was linear regression for paper I and logistic regression for papers II and III, adjusted for confounders. The data for paper IV was based on nationwide data from MBR and Statistics Finland. Paper IV included data on the most recent singleton delivery of all women who gave birth in Finland between years 2004–2014 (N=382,233). Women were classified into nine regional categories based on their country of origin. Generalised linear models were used to examine associations between the country of origin and mode of delivery or neonatal outcomes, adjusted for confounders. Finnish women were the reference group. In paper I, the mean pre-pregnancy BMI was lower in Russian women (adjusted coefficients −1.93, 95% CI −2.77 to −1.09), and higher in Somali (adjusted coefficients 1.82, 95% CI 0.89–2.75) and Kurdish women (adjusted coefficients 1.30, 95% CI 0.43 to 2.17) compared with women in the general population. No statistically significant differences were observed in the mean inter-pregnancy weight change between the Russian, Somali and Kurdish women compared with women in the general population. Paper II reported that Kurdish women had higher odds for gestational diabetes mellitus (adjusted OR 1.98, 95% CI; 1.20 to 3.32) compared with the general population, but the odds for hypertensive disorders did not differ between the migrant groups and women in the general population. In paper III, Russian women had lower odds (adjusted OR 0.49, 95% CI 0.29 to 0.82) of having a caesarean delivery, whereas Somali and Kurdish women did not differ from the reference group. Somali women had an increased risk of any delivery complications (adjusted OR 1.62, 95% CI 1.03 to 2.55) compared with women in the general population. Furthermore, no differences were observed in the use of pain medication between the groups. Paper IV reported that, compared with Finnish women, Sub-Saharan African women had higher risks for emergency caesarean delivery (adjusted RR 2.98, 95% CI 2.70 to 3.29), preterm births (adjusted RR 1.21, 95% CI 1.03 to 1.42), low birthweight (adjusted RR 1.99, 95% CI 1.60 to 2.33), lower 5-minute Apgar score (adjusted RR 2.59, 95% CI 2.18 to 3.08) and intensive care unit care (adjusted RR 1.36, 95% CI 1.23 to1.51) for newborns. South Asian and East Asian women were at an increased risk for emergency caesarean delivery (adjusted RR 2.17, 95% CI 1.91 to 2.46; adjusted RR 1.41, 95% CI 1.28 to 1.54, respectively), preterm birth (adjusted RR 1.45, 95% CI 1.19 to 1.77; adjusted RR 1.28, 95% CI 1.13 to 1.46, respectively), low birthweight (adjusted RR 2.43, 95% CI 2.08 to 2.94; adjusted RR 1.25, 95% CI 1.08 to 1.46, respectively) and lower 5-minute Apgar score (adjusted RR 2.06, 95% CI 1.55 to 2.76; adjusted RR 1.36, 95% CI 1.11 to 1.67, respectively) compared with Finnish women. Latin America/Caribbean women had higher risks for both elective and emergency caesarean delivery (adjusted RR 1.46, 95% CI 1.14 to1.87; adjusted RR 1.74, 95% CI 1.41 to 2.15, respectively) and lower 5-minute Apgar score (adjusted RR 1.95, 95% CI 1.30 to 2.91) compared with Finnish women. In conclusion, this study contributed to evidence on differences in pre-pregnancy BMI, prevalence of pregnancy and delivery complications, caesarean delivery and neonatal outcomes among women of migrant origin and Finnish women in Finland. More research is needed to better understand the reasons and mechanisms behind these differences and to develop interventions for improving the health outcomes among the higher-risk groups

Comparison of new psychiatric diagnoses among Finnish children and adolescents before and during the COVID-19 pandemic : A nationwide register-based study

BackgroundCoronavirus Disease 2019 (COVID-19) restrictions decreased the use of specialist psychiatric services for children and adolescents in spring 2020. However, little is known about the pattern once restrictions eased. We compared new psychiatric diagnoses by specialist services during pandemic and pre-pandemic periods. Methods and findingsThis national register study focused on all Finnish residents aged 0 to 17 years from January 2017 to September 2021 (approximately 1 million a year). The outcomes were new monthly diagnoses for psychiatric or neurodevelopmental disorders in specialist services. These were analyzed by sex, age, home location, and diagnostic groups. The numbers of new diagnoses from March 2020 were compared to predictive models based on previous years. The predicted and observed levels in March to May 2020 showed no significant differences, but the overall difference was 18.5% (95% confidence interval 12.0 to 25.9) higher than predicted in June 2020 to September 2021, with 3,821 more patients diagnosed than anticipated. During this period, the largest increases were among females (33.4%, 23.4 to 45.2), adolescents (34.4%, 25.0 to 45.3), and those living in areas with the highest COVID-19 morbidity (29.9%, 21.2 to 39.8). The largest increases by diagnostic groups were found for eating disorders (27.4%, 8.0 to 55.3), depression and anxiety (21.0%, 12.1 to 51.9), and neurodevelopmental disorders (9.6%, 3.0 to 17.0), but psychotic and bipolar disorders and conduct and oppositional disorders showed no significant differences and self-harm (-28.6, -41.5 to -8.2) and substance use disorders (-15.5, -26.4 to -0.7) decreased in this period. The main limitation is that data from specialist services do not allow to draw conclusions about those not seeking help. ConclusionsFollowing the first pandemic phase, new psychiatric diagnoses in children and adolescents increased by nearly a fifth in Finnish specialist services. Possible explanations to our findings include changes in help-seeking, referrals and psychiatric problems, and delayed service access.Author summary Why was this study done? Healthcare emergencies and conflicts pose real threats to the availability of psychiatric services for children and adolescents.Previous studies compared limited pandemic and pre-pandemic periods or they did not cover the whole spectrum of psychiatric or neurodevelopmental disorders.This study was done to provide a comprehensive overview of the patterns of new diagnoses among children and adolescents during the pandemic. What did the researchers do and find? This study compared the predicted and observed new diagnoses from March 2020 to September 2021 based on pre-pandemic data and analyzed data from 2017 to 2021 among approximately 1 million children and adolescents per year.No significant changes in diagnoses were seen during the first phase of the pandemic, from March to May 2020, but new diagnoses increased by 18.5% from June 2020 to September 2021.Particularly high increases were observed in females, adolescents, and those living in areas with the highest Coronavirus Disease 2019 (COVID-19) rates. The highest increases in diagnoses related to eating disorders, depression and anxiety disorders, and neurodevelopmental disorders. What do these findings mean? The rapid increases in primary and secondary diagnoses by specialist services after the first 3 months of the pandemic raises concerns about gaps in services, accessibility, and continuity after the pandemic.Changes in supply and demand can pose serious challenges for psychiatric services, as they adapt to provide efficient services for children and adolescents.These data emphasize the importance of preparing for sudden changes in service use due to healthcare emergencies or crises, including the ongoing pandemic and the current conflict in Europe.Peer reviewe

Registered psychiatric service use, self-harm and suicides of children and young people aged 0-24 before and during the COVID-19 pandemic : a systematic review

Background The COVID-19 pandemic has impacted on psychiatric symptoms of children and young people, but many psychiatric services have been disrupted. It is unclear how service use, self-harm and suicide has changed since the pandemic started. To gain timely information, this systematic review focused on studies based on administrative data that compared psychiatric service use, self-harm and suicide before and during the pandemic among children and young people. Methods and finding A systematic review of studies published in English from 1 January 2020 to 22 March 2021 was conducted, using the Web of Science, PubMed, Embase and PsycINFO databases. Increases or reductions in service use were calculated and compared using percentages. Of the 2,676 papers retrieved, 18 were eligible for the review and they provided data from 19 countries and regions. Most studies assessed changes during the early phase of the COVID-19 pandemic, from March to July 2020, and three assessed the changes until October 2020. Fifteen studies reported a total of 21 service use outcomes that were quantitively examined. More than three-quarters of the 21 outcomes (81%) fell by 5-80% (mean reduction = 27.9%, SD = 35%). Ten of the 20 outcomes for psychiatric emergency department (ED) services reduced by 5% to 80% (mean = 40.1%, SD = 34.9%) during the pandemic. Reductions in service use were also recorded for ED visits due to suicide ideation and self-harm, referrals to secondary mental health services, psychiatric inpatient unit admissions and patients receiving treatment for eating disorders. However, there were also some increases. Suicide rate and the number of ED visits due to suicide attempts have increased, and there was an increase in the number of treatment sessions in a service that provided telemedicine. Conclusion Most of the studies showed reductions in the use of psychiatric services by children and young people during the early phase of the pandemic and this highlighted potential delays or unmet needs. Suicide rate has increased during the second wave of the pandemic. Further studies are needed to assess the pattern of service use in the later phases of the COVID-19 pandemic.Peer reviewe

A systematic review of the mental health changes of children and young people before and during the COVID-19 pandemic

There is increasing knowledge that the COVID-19 pandemic has had an impact on mental health of children and young people. However, the global evidence of mental health changes before compared to during the COVID-19 pandemic focusing on children and young people has not been systematically reviewed. This systematic review examined longitudinal and repeated cross-sectional studies comparing before and during COVID-19 pandemic data to determine whether the mental health of children and young people had changed before and during the COVID-19 pandemic. The Web of Science, PubMed, Embase and PsycINFO databases were searched to identify peer-reviewed studies that had been published in English and focused on children and young people between 0 and 24 years of age. This identified 21 studies from 11 countries, covering more than 96,000 subjects from 3 to 24 years of age. Pre-pandemic and pandemic data were compared. Most studies reported longitudinal deterioration in the mental health of adolescents and young people, with increased depression, anxiety and psychological distress after the pandemic started. Other findings included deteriorated negative affect, mental well-being and increased loneliness. Comparing data for pandemic and pre-pandemic periods showed that the COVID-19 pandemic may negatively impact the mental health of children and young people. There is an urgent need for high-quality research to address the impact, risks and protective factors of the pandemic on their mental health, as this will provide a good foundation for dealing with future health emergencies and other crises

Registered psychiatric service use, self-harm and suicides of children and young people aged 0–24 before and during the COVID-19 pandemic: a systematic review

BackgroundThe COVID-19 pandemic has impacted on psychiatric symptoms of children and young people, but many psychiatric services have been disrupted. It is unclear how service use, self-harm and suicide has changed since the pandemic started. To gain timely information, this systematic review focused on studies based on administrative data that compared psychiatric service use, self-harm and suicide before and during the pandemic among children and young people.Methods and findingA systematic review of studies published in English from 1 January 2020 to 22 March 2021 was conducted, using the Web of Science, PubMed, Embase and PsycINFO databases. Increases or reductions in service use were calculated and compared using percentages. Of the 2,676 papers retrieved, 18 were eligible for the review and they provided data from 19 countries and regions. Most studies assessed changes during the early phase of the COVID-19 pandemic, from March to July 2020, and three assessed the changes until October 2020. Fifteen studies reported a total of 21 service use outcomes that were quantitively examined. More than three-quarters of the 21 outcomes (81%) fell by 5–80% (mean reduction = 27.9%, SD = 35%). Ten of the 20 outcomes for psychiatric emergency department (ED) services reduced by 5% to 80% (mean = 40.1%, SD = 34.9%) during the pandemic. Reductions in service use were also recorded for ED visits due to suicide ideation and self-harm, referrals to secondary mental health services, psychiatric inpatient unit admissions and patients receiving treatment for eating disorders. However, there were also some increases. Suicide rate and the number of ED visits due to suicide attempts have increased, and there was an increase in the number of treatment sessions in a service that provided telemedicine.ConclusionMost of the studies showed reductions in the use of psychiatric services by children and young people during the early phase of the pandemic and this highlighted potential delays or unmet needs. Suicide rate has increased during the second wave of the pandemic. Further studies are needed to assess the pattern of service use in the later phases of the COVID-19 pandemic.</p

Health of Pregnant Migrant Women and their Newborns in Finland

Tämän väitöskirjan yleisenä tavoitteena oli tutkia raskaana olevien maahanmuuttajanaisten ja heidän vastasyntyneiden lastensa terveyttä Suomessa. Tutkimukseen kuuluu neljä osatyötä (Artikkelit I-IV). Tutkimuksen tavoitteina oli tutkia raskautta edeltävää keskimääräistä kehon painoindeksiä ja raskauksien välistä painonmuutosta (Artikkeli I), raskauskomplikaatioiden kuten raskausdiabeteksen ja verenpainetautien yleisyyttä (Artikkeli II), ja synnytystapaa ja synnytyskomplikaatioiden yleisyyttä (Artikkeli III) venäläis-, somalialais- ja kurditaustaisilla naisilla ja suomalaisilla naisilla. Artikkelissa IV tutkittiin eroja suunnitellun ja hätäkeisarileikkauksen yleisyydessä ja vastasyntyneeseen lapseen liittyvien vasteiden yleisyydessä (ennenaikaisen syntymä, pienipainoisuus, Apgarin pisteet ja vastasyntyneen tehohoito) kaikkien maahanmuuttajataustaisten ja suomalaistaustaisten naisten välillä Suomessa. Kolmen ensimmäisen osatyön aineisto perustui otokseen venäläis-, somalialaisja kurditaustaisista naisista. Nämä naiset tunnistettiin väestörekisteristä Maahanmuuttajien terveys ja hyvinvointi -tutkimusta varten. Vertailuotoksen suomalaiseen väestöön kuuluvat naiset otettiin kansallisesta Terveys 2011 tutkimuksesta. Heidän tietonsa saatiin Terveyden ja hyvinvoinnin laitoksen (THL) syntyneiden lasten rekisteristä ja hoitoilmoitusrekisteristä sekä Tilastokeskuksesta. Artikkeleihin I-III otettiin mukaan yhteensä 318 venäläis-, 583 somalialais- ja 373 kurditaustaista naista sekä 243 suomalaiseen väestöön kuuluvaa naista ja tiedot heidän viimeisimmästä yhden lapsen synnytyksestä vuosien 2004 ja 2014 välillä. Lineaarinen regressioanalyysi oli tärkein analyysimenetelmä Artikkelissa I ja logistinen regressioanalyysi artikkeleissa II ja III. Sekoittavia tekijöitä vakioitiin analyyseissä. Artikkelin IV aineisto perustui koko maan kattavaan aineistoon THL:n syntyneiden lasten rekisteristä ja Tilastokeskuksen taustatiedoista. Artikkeliin IV otettiin mukaan kaikilta Suomessa vuosina 2004-2014 synnyttäneiltä naisilta tiedot viimeisimmästä yhden lapsen synnytyksestä (n=382,233). Naiset luokiteltiin yhdeksään alueelliseen luokkaan alkuperämaan perusteella. Alkuperämaan ja synnytystavan tai vastasyntyneen lapsen vasteiden välisiä yhteyksiä tutkittiin yleistetyillä lineaarisilla malleilla, sekoittavat tekijät vakioiden. Suomalaiset naiset olivat vertailuryhmänä. Artikkelin I tulosten mukaan raskautta edeltävä painoindeksi oli pienempi venäläistaustaisilla (vakioitu kerroin -1,93, 95 % luottamusväli (lv) -2,77; -1,09) ja suurempi somalialaistaustaisilla (vakioitu kerroin 1,82, 95 % lv 0,89; 2,75) ja kurditaustaisilla (vakioitu kerroin 1,3, 95 % lv 0.43; 2,17) naisilla suomalaisväestöön nähden. Raskauksien välisessä painonmuutoksessa ei havaittu tilastollisesti merkitseviä eroja venäläis-, somalialais- ja kurditaustaisten naisten ja suomalaisten naisten välillä. Artikkelin II tulosten mukaan raskausdiabetes oli yleisempää kurditaustaisilla naisilla suomalaisiin naisiin verrattaessa (vakioitu vetosuhde, OR 1,98, 95 % lv 1,20; 3,32), mutta verenpainetautien yleisyydessä ei ollut eroa maahanmuuttajaryhmien ja suomalaisten naisten välillä. Artikkelissa III havaittiin, että keisarileikkaukset olivat harvinaisempia venäläistaustaisilla naisilla (vakioitu OR 0,49, 95 % lv 0,29; 0,82), mutta somalialais- ja kurditaustaisten ja suomalaisten naisten välillä ei havaittu eroa. Synnytyskomplikaatiot olivat yleisempiä somalialaistaustaisilla naisilla (vakioitu OR 1.62, 95 % lv 1,03; 2,55) kuin suomalaisilla naisilla. Ryhmien välillä ei ollut eroa kipulääkityksen käytössä. Artikkelin IV tulokset osoittivat, että Saharan eteläpuolisesta Afrikasta kotoisin olevilla oli suurempi hätäkeisarileikkauksen (vakioitu RR 2,98, 95 % lv 2,70; 3,29), ennenaikaisen synnytyksen (vakioitu RR 1,21, 95 % lv 1,03; 1,42), pienipainoisuuden (vakioitu RR 1,99, 95 % lv 1,60; 2,33), matalampien 5 minuutin Apgar-pisteiden (vakioitu RR 2,59, 95 % lv 2,18; 3,08) ja vastasyntyneen tehohoidon riski (vakioitu RR 1,36, 95 % lv 1,23; 1,51). Etelä-Aasiasta ja Itä-Aasiasta kotoisin olevilla oli suurempi hätäkeisarileikkauksen (vakioidut RR:t 2,17, 95 % lv 1,91; 2,46 ja 1,41, 95 % lv 1,28; 1,54), ennenaikaisuuden (vakioidut RR:t 1,45, 95 % lv 1,19; 1,77 ja 1,28, 95 % lv 1,13; 1,46), pienipainoisuuden (vakioidut RR:t 2,43, 95 % lv 2,08; 2,94 ja 1,25, 95 % lv 1,08; 1,46,) ja matalampien 5 minuutin Apgar-pisteiden riski (vakioidut RR:t 2,06, 95 % lv 1,55; 2,76 ja 1,36, 95 % lv 1,11; 1,67) suomalaistaustaisiin synnyttäjien nähden. Etelä-Amerikasta tai Karibialta kotoisin olevilla oli suurempi riski sekä suunnitellulle että hätäkeisarileikkaukselle (vakioidut RR:t 1,46, 95 % lv 1,14; 1,87 ja 1,74, 95 % lv 1,41; 2,15) ja matalammille 5 minuutin Apgar pisteille (vakioitu RR 1.95, 95 % lv 1.30; 2,91) suomalaisiin vertaillessa. Johtopäätöksenä voidaan todeta, että tämä tutkimus tuo uutta tietoa raskautta edeltävästä painoindeksistä ja raskaus- ja synnytyskomplikaatioiden, keisarileikkausten ja vastasyntyneen lapsen vasteiden yleisyydestä Suomessa asuvilla maahanmuuttajataustaisilla naisilla. Tarvitaan lisää tutkimusta, jotta voidaan ymmärtää paremmin näiden erojen taustalla olevia syitä ja mekanismeja sekä kehittää interventioita riskiryhmien terveyden parantamiseen.The general aim of this dissertation was to examine the health of pregnant migrant women and their newborns in Finland. To accomplish the aim, four studies were conducted (papers I–IV) in total. The objectives of this thesis were to study mean pre-pregnancy body mass index and inter-pregnancy weight change (paper I); prevalence of pregnancy complications, mainly gestational diabetes and hypertensive disorders (paper II); mode of delivery; and prevalence of delivery complications (paper III) among women of Russian, Somali and Kurdish origin as well as the general Finnish population. Paper IV studied differences in the prevalence of elective and emergency caesarean delivery and neonatal outcomes, mainly preterm birth, low birthweight, Apgar score and admission in the neonatal intensive care unit between all women of migrant origin and Finnish women in Finland. The data for the first three papers were based on a sample of migrant women of Russian, Somali and Kurdish origin. These groups were identified from the Population Register of the Migrant Health and Wellbeing Survey. The sample of the reference group, women in the general population, were identified from the nationallevel Health 2011 Survey. Their data were extracted from the Finnish Medical Birth Register (MBR), Statistics Finland and the Care Register for Health Care. In total, 318 Russian, 583 Somali, 373 Kurdish and 243 women from the general population and data on their most recent singleton birth in Finland, between years 2004–2014, were included in papers I–III. The main method of analysis was linear regression for paper I and logistic regression for papers II and III, adjusted for confounders. The data for paper IV was based on nationwide data from MBR and Statistics Finland. Paper IV included data on the most recent singleton delivery of all women who gave birth in Finland between years 2004–2014 (N=382,233). Women were classified into nine regional categories based on their country of origin. Generalised linear models were used to examine associations between the country of origin and mode of delivery or neonatal outcomes, adjusted for confounders. Finnish women were the reference group. In paper I, the mean pre-pregnancy BMI was lower in Russian women (adjusted coefficients −1.93, 95% CI −2.77 to −1.09), and higher in Somali (adjusted coefficients 1.82, 95% CI 0.89–2.75) and Kurdish women (adjusted coefficients 1.30, 95% CI 0.43 to 2.17) compared with women in the general population. No statistically significant differences were observed in the mean inter-pregnancy weight change between the Russian, Somali and Kurdish women compared with women in the general population. Paper II reported that Kurdish women had higher odds for gestational diabetes mellitus (adjusted OR 1.98, 95% CI; 1.20 to 3.32) compared with the general population, but the odds for hypertensive disorders did not differ between the migrant groups and women in the general population. In paper III, Russian women had lower odds (adjusted OR 0.49, 95% CI 0.29 to 0.82) of having a caesarean delivery, whereas Somali and Kurdish women did not differ from the reference group. Somali women had an increased risk of any delivery complications (adjusted OR 1.62, 95% CI 1.03 to 2.55) compared with women in the general population. Furthermore, no differences were observed in the use of pain medication between the groups. Paper IV reported that, compared with Finnish women, Sub-Saharan African women had higher risks for emergency caesarean delivery (adjusted RR 2.98, 95% CI 2.70 to 3.29), preterm births (adjusted RR 1.21, 95% CI 1.03 to 1.42), low birthweight (adjusted RR 1.99, 95% CI 1.60 to 2.33), lower 5-minute Apgar score (adjusted RR 2.59, 95% CI 2.18 to 3.08) and intensive care unit care (adjusted RR 1.36, 95% CI 1.23 to1.51) for newborns. South Asian and East Asian women were at an increased risk for emergency caesarean delivery (adjusted RR 2.17, 95% CI 1.91 to 2.46; adjusted RR 1.41, 95% CI 1.28 to 1.54, respectively), preterm birth (adjusted RR 1.45, 95% CI 1.19 to 1.77; adjusted RR 1.28, 95% CI 1.13 to 1.46, respectively), low birthweight (adjusted RR 2.43, 95% CI 2.08 to 2.94; adjusted RR 1.25, 95% CI 1.08 to 1.46, respectively) and lower 5-minute Apgar score (adjusted RR 2.06, 95% CI 1.55 to 2.76; adjusted RR 1.36, 95% CI 1.11 to 1.67, respectively) compared with Finnish women. Latin America/Caribbean women had higher risks for both elective and emergency caesarean delivery (adjusted RR 1.46, 95% CI 1.14 to1.87; adjusted RR 1.74, 95% CI 1.41 to 2.15, respectively) and lower 5-minute Apgar score (adjusted RR 1.95, 95% CI 1.30 to 2.91) compared with Finnish women. In conclusion, this study contributed to evidence on differences in pre-pregnancy BMI, prevalence of pregnancy and delivery complications, caesarean delivery and neonatal outcomes among women of migrant origin and Finnish women in Finland. More research is needed to better understand the reasons and mechanisms behind these differences and to develop interventions for improving the health outcomes among the higher-risk groups

Trends in the Prevalence of Overweight and Obesity Among Women of Reproductive Age

BACKGROUND: Information on trends in the prevalence of overweight and obesity and the high-risk groups helps plan health promotion programmes and health policy. This study examined trends in overweight and obesity from 2006 to 2016 and the associated socio-demographic factors in 2016 among 20 to 49-year-old women in Nepal. METHODS: Nationally representative cross-sectional data were used from three Demographic and Health Surveys conducted in 2006 (n=7809), 2011 (n=4561), and 2016 (n=4904) in Nepal. Bodyweight and height were measured by trained personnel. Overweight was defined as 23.0 to 27.5 kg/m2 and obesity as >27.5 kg/m2 based on Asian-specific criteria in the main analyses. Multinomial logistic regression models were adjusted for age, parity, education, and wealth index. RESULTS: The prevalence of overweight increased from 16.6% to 26.8% and obesity from 3.9% to 14.3% between 2006 and 2016. The adjusted odds ratios and 95% confidence intervals were 2.26 (2.06 to 2.49) for overweight and 5.26 (4.48 to 6.18) for obesity in 2016 compared with 2006. Age 30 to 49 years, higher wealth index, parity 1 to 3 and education were associated with a higher prevalence of overweight and obesity, whereas the association between the area of residence (urban/rural) and prevalence of overweight or obesity was not statistically significant. CONCLUSIONS: The prevalence of overweight and obesity increased among Nepalese women of reproductive age between 2006 and 2016. More research is needed on how to prevent overweight and obesity among women, especially women aged 30 to 49 years or with higher wealth, in Nepal.publishedVersionPeer reviewe