Mülteci statüsü ve anne yaşının gebelik sonuçları üzerindeki etkisi: Türkiye'den karşılaştırmalı bir çalışma

Abstract

Amaç: Bu çalışmanın amacı, Suriyeli mülteci ve yerli Türk adölesan gebelerin sosyodemografik, obstetrik ve neonatal sonuçlarını erişkin kadınlarla karşılaştırmalı olarak inceleyerek olumsuz maternal ve neonatal sonuçların esas olarak genç anne yaşından mı kaynaklandığını yoksa Suriyeli mülteci statüsü ile daha da mı kötüleştiğini ortaya koymaktır. Yöntem: Bu retrospektif kohort çalışmasında, Türkiye’nin devlet destekli sağlık sistemine bağlı üçüncü basamak bir merkezde Ocak 2015 ile Aralık 2018 tarihleri arasında gerçekleşen 23.832 doğum analiz edilmiş olup, dahil edilme kriterlerini karşılayan 5.720 tekil gebelik değerlendirmeye alınmıştır. Çalışma grubu, 15–19 yaş aralığında 2.235 adölesan gebeyi (985 Suriyeli mülteci, 1.250 Türk vatandaşı) ve 20–35 yaş aralığında 3.485 erişkin gebeyi kapsamaktadır. Gruplar arasında sosyodemografik özellikler ile obstetrik ve neonatal sonuçlar karşılaştırılmıştır. Bulgular: Mülteci adölesanlar, diğer gruplara kıyasla daha genç yaşta olup, vücut kitle indeksleri daha düşüktü, gebelik süresince yetersiz kilo alımı gösterdiler ve antenatal bakım hizmetlerinden daha az faydalandılar (p<0.001). Sigara kullanımı ve evli olmama durumu yerli adölesanlar arasında daha yaygınken (p<0.001), okuryazarlık oranı mülteci adölesanlar arasında anlamlı düzeyde daha düşüktü (p<0.001). Mülteci adölesanlarda birinci ve ikinci trimester prenatal tarama testlerinin yapılma oranı daha düşük, ancak gestasyonel diyabet (GDM) tarama oranı daha yüksekti (p<0.001). Sezaryen doğum oranı erişkin gebelerde daha yüksekken, mülteci adölesanlar arasında vajinal doğum daha yaygındı (p<0.001). Mülteci adölesanlarda preeklampsi ve preterm doğum oranları daha yüksekken, GDM erişkinlerde daha sık görüldü (p<0.001). Sonuç: Adölesan gebelik, maternal ve neonatal sağlık açısından ciddi riskler taşımaktadır; bu riskler Suriyeli mülteci adölesanlar arasında sosyoekonomik eşitsizlikler, dil engelleri, sınırlı eğitim olanakları ve sağlık hizmetlerine erişimdeki kısıtlılıklar nedeniyle daha da artmaktadır. Antenatal bakım hizmetlerinin güçlendirilmesi, doğurganlık ve üreme sağlığına yönelik kapsamlı eğitim programlarının yaygınlaştırılması, aile planlaması desteği sunulması ve çocuk yaşta evliliklerin önlenmesi amacıyla hedeflenmiş müdahalelere acil ihtiyaç vardır.

Keywords

• Adölesan gebelik
• olumsuz gebelik sonuçları
• antenatal bakım
• çocuk evliliği
• sağlık eşitsizlikleri
• yerli adölesanlar
• mülteci adölesanlar

Impact of refugee status and maternal age on pregnancy outcomes: a comparative study from Turkiye

Abstract

Aims: This study aimed to elucidate sociodemographic, obstetric, and neonatal outcomes among Syrian refugee and native Turkish adolescents compared with adult women, to determine whether adverse maternal and neonatal outcomes are primarily attributable to young maternal age or exacerbated by Syrian refugee status. Methods: This retrospective cohort study analyzed 23,832 deliveries at a tertiary care center in Turkiye’s state-funded healthcare system from January 2015 to December 2018, with 5,720 singleton pregnancies meeting inclusion criteria. The study population comprised 2,235 adolescent pregnant women aged 15-19 years (985 Syrian refugees and 1,250 Turkish natives) and 3,485 adult pregnant women aged 20-35 years. Sociodemographic characteristics, obstetric and neonatal outcomes were compared between the groups. Results: Refugee adolescents were younger, had a lower body mass index, insufficient weight gain during pregnancy and had inadequate antenatal care compared to other groups (p<0.001). Smoking and being unmarried were more prevalent among native adolescents (p<0.001), however the illiteracy rate was significantly higher among refugee adolescents (p<0.001). First- and second-trimester prenatal screening tests uptake was lower among refugee adolescents, but gestational diabetes mellitus (GDM) screening rates were higher (p<0.001). The cesarean delivery rate was higher among adult pregnant women, while vaginal deliveries were more common among refugee adolescents (p<0.001). Refugee adolescents experienced higher rates of pre-eclampsia and preterm birth, whereas GDM was more prevalent among adults (p<0.001). Conclusion: Adolescent pregnancy is associated with significant maternal and neonatal health risks, exacerbated among Syrian refugee adolescents due to socioeconomic disparities, language barriers, limited education, and limited access to healthcare facilities. Targeted interventions are urgently needed to improve antenatal care and provide comprehensive education on fertility and reproductive health, support family planning, and prevent child marriage.

Keywords

• Adolescent pregnancy
• adverse pregnancy outcomes
• antenatal care
• health disparities
• native adolescents
• refugee adolescents

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