Perinatal and Neonatal Outcomes of Grand Multiparous Refugee Women Under the Age of Thirty-Five: A Comparative Study

Abstract

OBJECTIVES: To compare maternal and neonatal outcomes between grand multiparous Syrian refugee women younger than 35 years and Türkiye citizens.

STUDY DESIGN: In this retrospective cohort study we screened electronic birth records according to predefined eligibility criteria. Of 313 potentially eligible women, 16 were excluded because their patient files could not be accessed, leaving 297 grand multiparous women aged 18–34 years (150 Türkiye citizens and 147 Syrian refugees) who delivered at Adiyaman University Faculty of Medicine Education and Research Hospital. Women aged <18 or ≥35 years, those with multiple pregnancies, and refugees with Türkiye citizenship were excluded. We compared groups and used multivariable logistic regression; adjusted models for neonatal intensive care unit (NICU) admission, cesarean delivery, and gestational diabetes mellitus (GDM) included maternal age, parity, and gestational age at delivery.

RESULTS: NICU admission was more frequent among Syrian refugee neonates (16.3% vs. 8.7%, p=0.046) and remained associated with refugee status after adjustment (adjusted odds ratio 2.42, 95% CI 1.11-5.26; p=0.026). Cesarean delivery, blood transfusion, 5-minute Apgar score <7, and diagnosed GDM did not differ significantly. Missing GDM data were substantially more frequent among Syrian refugees (57.1% vs. 4.7%).

CONCLUSION: Syrian refugee status was independently associated with higher NICU admission in this age-restricted grand-multiparous cohort, identifying neonatal intensive care requirement as the principal observed difference. This focused comparison highlights a clinically relevant neonatal disparity; nonsignificant differences in other outcomes do not establish equivalence or comparable healthcare access.