Pregnancy and neonatal outcomes of aboriginal women: a systematic review and meta-analysis.
PURPOSE: inadequate prenatal care and higher incidences of higher-risk behaviors and gestational diabetes, in addition to other significant determinants of health, place aboriginal women at increased risk of adverse pregnancy outcomes. We conducted a systematic review and meta-analyses of pregnancy and neonatal outcomes among aboriginal women. METHODS: we searched Medline, Embase, and CINAHL for English-language studies reporting rates of pregnancy and neonatal outcomes among aboriginal women. Data were extracted by three reviewers in duplicate. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Data were synthesized using random effect model. Subgroup analyses were performed based on the country of origin of the aboriginal women. RESULTS: thirty-eight studies of low to moderate risk of biases were included. Adjustment for confounding factors was performed in eight studies. Unadjusted odds of low birth weight (LBW), preterm birth (PTB), stillbirth, neonatal and perinatal mortality were increased among infants born to aboriginal women. However, adjusted odds were only increased for PTB and stillbirths. Subgroup analyses revealed higher unadjusted odds of LBW, PTB, stillbirth, and neonatal and perinatal mortality among Australian aboriginals; PTB, macrosomia, stillbirth and neonatal and perinatal mortality among Canadian aboriginals, and PTB and neonatal mortality among American Indians and Alaskan Native women. CONCLUSION: aboriginal women are at increased risk of adverse pregnancy outcomes especially PTB; however, future studies assessing confounders adjusted estimates are needed. Differences in outcomes exist based on the country of origin of aboriginal women, reasons for which should be investigated.