Pregnancy outcomes in urban Aboriginal women

OBJECTIVE: To assess Aboriginal women's access to antenatal care and their pregnancy outcomes in an urban setting. DESIGN: Retrospective descriptive study using an obstetric database. SETTING: King George V Memorial Hospital, Sydney. PATIENTS: All women who gave birth between 1 January 1992 and 31 December 1993. OUTCOME MEASURES: Age and parity, gestation at first antenatal visit and at delivery, antenatal complications, type of delivery, infant birthweights and perinatal mortality were compared between Aboriginal and non-Aboriginal women. Within the Aboriginal group, comparisons were made between those with and without poor pregnancy outcomes (low birthweight infants and perinatal deaths). RESULTS: Aboriginal women were younger and of higher parity than non-Aboriginal women and booked for confinement later in pregnancy, although nearly 80% were booked by 28 weeks' gestation. There was more pregnancy-induced hypertension (P < 0.01; relative risk RR, 1.66; 95% confidence interval Cl, 1.17-2.37), urinary tract infection (P < 0.02; RR, 2.45; 95% Cl, 1.27-4.30) and need for methadone stabilisation in Aboriginal women (P < 0.001; RR, 5.88; 95% Cl, 2.99-11.57). In the Aboriginal group, there were higher preterm delivery rates (P < 0.001; 95% Cl, 1.31-2.74), more low birthweight babies (P < 0.001; 95% Cl, 1.67-3.33) and higher perinatal mortality rates. These findings applied to both Aboriginal women transferred from metropolitan district and country hospitals and those resident in central Sydney. Factors associated with low birthweight and perinatal deaths in Aboriginal infants included late antenatal booking, cigarette smoking, hypertension and urinary tract infection in pregnancy, and antepartum haemorrhage. CONCLUSION: Further efforts must be made to improve access of Aboriginal women to antenatal services in the Central Sydney Area to improve perinatal outcomes and maternal health.