The factors that cause differences in maternal and infant health are complex and multifactorial. Most studies on racial and ethnic disparities in prenatal care among pregnant women have investigated a limited number of measures, primarily the initiation and frequency of antenatal care visits. In the majority of these studies, only differences between white and black women were investigated. Some studies have proposed that several factors may contribute to racial and ethnic disparities in pregnant women, like socioeconomic disadvantages, maternal stress, perceived racism, smoking, alcohol consumption, and substance abuse. These can lead to birth outcomes such as maternal morbidity
10. The intersection of race, gender, poverty, and other social factors shape the individuals' experiences and outcomes, particularly in maternal and infant health
11.
Pregnant women living in war zones may face adverse pregnancy outcomes such as preterm birth, low birth weight, increased fetal death, and increased obstetric complications 12. With the civil war that started in Syria, most people had to leave their country. Migration, which initially began in small groups, gradually turned into large migration movements. Adıyaman most of which is located in the Southeastern Anatolia Region, is a province where Syrian immigrants predominantly reside. According to the data of the Refugees Association, the number of Syrians living in Adıyaman as of 26 May 2022 is 23286 (https://multeciler.org.tr/turkiyedeki-suriyeli-sayisi/).
But the actual number is assumed to be above this. Syrian patients have free access to migrant health centers and all hospitals. Syrian pregnant women can benefit from all pregnancy health services free of charge in Turkey. In addition, they can benefit from translation services in migrant health centers and hospitals 13. The only hospital in the city Syrians can visit is our hospital. Ozel et al. 14 reported that only 23% of pregnant Syrian refugees received prenatal care in Ankara in 2015. Previous studies showed that Syrian migrant pregnant women had low antenatal care, lower gestational age, and higher adolescent pregnant women compared to the control group 15,16.
In this study, we intended to compare the demographic and clinical characteristics of Turkish and Syrian pregnant women living in Adıyaman and we evaluated 300 Syrian and 300 Turkish pregnant women. Our results showed a significant difference between the groups regarding some values. In previous works, it has been demonstrated that Syrian refugees who were pregnant were younger than Turkish women who were pregnant 17,18. However, in this study, no difference is found between the age of Turkish and Syrian women (Table 1). Furthermore, there is no difference between the two groups regarding pregnancy over the age of 35. Immigrants have been in Turkey since 2012, and this may be because the Syrian patients who come to hospitals over the years are not as young as they first arrived.
Some studies have reported higher cesarean delivery rates in Turkish women than in Syrian women 18-20. On the other hand, in this work, it is shown that there is no statistically significant difference between the groups regarding birth type. Kıyak et al. 18 and Gungor et al. 19 reported that there was no difference in the two groups' rates of stillbirth or fetal anomalies between the Turkish and Syrian pregnant groups. We also have found the same results in terms of stillbirth and fetal anomalies. Moreover, no difference has been observed between Turkish and Syrian pregnant women in terms of age >35, gravida, baby weight, type of birth, baby gender, preterm birth, anemia, eclampsia, and GDM.
Canturk et al. 20 reported that hemoglobin values were lower in the Syrian group compared to Turks. In our study, hemoglobin values are similar in both groups. It has been found that preeclampsia is more common in Turkish women compared to Syrian women. This is consistent with data from Kıyak et al. 18 and Demirci et al. 21. Thus, it can be explained that Turkish pregnant women are less followed in a tertiary center in antenatal care. While access to a tertiary center is not limited, we think most Turkish pregnant women have a prenatal follow-up in primary health care centers due to easy access. The fact that Syrian patients in our country are not yet directly affiliated with family medicine and can go to any hospital they want may be an adequate reason for this. The genetic background of preeclampsia may also be one of the factors. IUGR and screening test rate were lower in Syrian women than in Turkish women (Table 1). We think that IUGR may be caused by the reasons such as malnutrition and lack of follow-up. The lack of screening tests may be due to the lack of regular follow-ups. The low rate of screening tests may also be due to the belief that the child is willing to give birth regardless of whether the child is sick or not.
We have evaluated hemoglobin, Vitamin B12, TSH, and Vitamin D levels and routinely checked all pregnant women. Although hemoglobin, Vitamin B12, and TSH values were similar, Vitamin D levels were significantly lower in Syrian women compared to Turkish women (Table 2). Vitamin D deficiency and insufficiency are common all over the world. Epidemiological studies show that vitamin D deficiency is common in women, including prenatal and lactating mothers 22. It has been shown that low vitamin D is associated with adverse maternal conditions such as gestational diabetes mellitus 23, pregnancy-related hypertension 24, recurrent pregnancy losses 25, high blood pressure in diabetic pregnancy 26, and postpartum depression 27. Pregnant women with Vitamin D levels below 12 ng/mL were statistically higher in Syrian women (45.7% vs. 16%). It may be related to women's lack of control and dressing style. Vitamin D insufficiency and normal levels were higher in Turkish women than in Syrian women (Table 3).
Some limitations existed in this study. Firstly, our study samples were relatively small and this was a retrospective study. Thus, more extensive community-based studies are needed. The second limitation is that our data only reflects the population living in one region. Consequently, it might not represent the entire Turkish community. The other is that only pregnant women who applied to our hospital were selected. Thus, although it is considered that the number of pregnant women followed in different centers in the city is low, these data could not be reached. On the other hand, accessing many parameters from the hospital data system is a great advantage in terms of accuracy.
)
)
)