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. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Pregnancy Immigrant Risk factor Asylum seeker Maternal morbidity

physical activity Netherlands unemployment prospective study immigrant household refugee prenatal care Pregnancy Complications mental health human Prospective Studies Refugees Cohort Studies risk assessment ethnic group Human immunodeficiency virus infected patient priority journal controlled study comparative study intensive care unit language asylum seeker social status maternity ward Humans female risk factor Risk Factors obstetric hemorrhage late gestational booking severe acute maternal morbidity pregnancy Incidence women's health Article major clinical study adult uterus rupture HELLP syndrome eclampsia outcome assessment cohort analysis multipara maternal morbidity pregnant woman disease severity social class cesarean section