# Comparative analysis of perinatal health outcomes among refugee subgroups and economic immigrants in Canada (2000–2017)

## TL;DR

This study compares perinatal health outcomes among refugee subgroups and economic immigrants in Canada, finding higher risks of preterm and large-for-gestational-age births among refugees.

## Contribution

The study provides a detailed comparison of perinatal health outcomes across different refugee subgroups and economic immigrants in Canada.

## Key findings

- Refugee subgroups had higher preterm birth and large-for-gestational-age rates compared to economic immigrants.
- In-Canada Refugees had higher stillbirth and small-for-gestational-age risks compared to other refugee subgroups.
- Maternal and immigration-related factors partially explain the observed health disparities.

## Abstract

Refugees often face increased risks of poor perinatal health outcomes compared to native-born individuals and non-refugee immigrants. However, limited research has explored how birth outcomes vary across refugee subgroups in Canada, especially compared to economic immigrants and among refugee groups themselves. This study aimed to (1) compare the risk of preterm birth (PTB), small-for-gestational-age (SGA), large-for-gestational-age (LGA), stillbirth, and infant mortality between refugee subgroups and economic immigrants, and (2) examine differences among Government-Assisted Refugees (GARs), Privately Sponsored Refugees (PSRs), and In-Canada Refugees (ICRs).

This population-based study used data from the Migrant Maternal and Infant Morbidity and Mortality (MIMMM) dataset, including 706,620 singleton births from 2000 to 2017. Generalized estimating equation models calculated adjusted risk ratios (aRRs) for birth outcomes, accounting for maternal and immigration-related factors.

All refugee subgroups had higher PTB (6.26–6.41 per 100 births) and LGA rates (8.65–9.17 per 100 births) but lower SGA rates (9.53–10.40 per 100 births) compared to economic immigrants (PTB: 5.95, LGA: 7.36, SGA: 10.96). After adjustment, GARs maintained higher PTB risks, and all refugee subgroups had lower SGA and higher LGA risks than economic immigrants. Within refugee subgroups, ICRs had higher SGA risks (aRR = 1.09; 95% CI: 1.04–1.14) than GARs, and PSRs (aRR = 1.22; 95% CI: 1.04–1.44) and ICRs (aRR = 1.28; 95% CI: 1.07–1.52) had higher stillbirth risks than GARs.

Refugee women in Canada have higher risks of PTB and LGA births compared to economic immigrants. ICRs had higher risks of SGA births and stillbirths than other refugee subgroups but lower risks of SGA and stillbirths compared to economic immigrants. These disparities are partly explained by maternal and immigration-related factors. Further research is needed to better understand these factors and inform policies aimed at reducing health disparities among immigrant populations in Canada.