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Adverse effects of exposure to armed conflict on pregnancy : a systematic review

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Keasley, James, Blickwedel, Jessica and Quenby, Siobhan (2017) Adverse effects of exposure to armed conflict on pregnancy : a systematic review. BMJ Global Health, 2 (4). e000377. doi:10.1136/bmjgh-2017-000377

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Official URL: http://dx.doi.org/10.1136/bmjgh-2017-000377

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Abstract

Exposure to armed conflict has manifold implications for both military and civilian populations. Prenatal stress has detrimental effects on both obstetric outcomes, fetal development and the development of an individual later in life. As well as causing stress to the mother, armed conflicts can decimate local infrastructures making it increasingly difficult to access antenatal and general healthcare. The present review is particularly salient in light of the many ongoing current conflicts. It examines the impacts of exposure to armed conflicts on the pregnancy outcomes.A thorough literature search was carried out on three databases using MeSH and truncation terms. 13 studies were included in the final analysis relating to mothers exposed to armed conflicts since 1990.The studies include data from 1 172 151 patients: mothers from Libya, Bosnia, Herzegovina, Israel, Palestine, Kosovo, Yugoslavia, Nepal, Somalia, Iraq, Kuwait and Afghanistan. There is evidence of an increased risk of mothers giving birth to babies of low birth weight as reported in nine included studies. All have a degree of bias, with four at lower and five at higher risk of bias, either not adjusting for confounders or not employing robust measures of exposure to conflict. Further evidence suggested an increase in the incidence of miscarriage, stillbirth, prematurity, congenital abnormalities, miscarriage and premature rupture of membranes among mothers exposed to armed conflict.Despite the varying degrees of bias which must be considered for the available evidence, the data with the lowest risk of bias suggest a relationship between exposure to armed conflict and low birth weight. In light of the current level of displacement experienced by such populations, the identification of pregnancies at risk could improve the efficacy of antenatal care. Clinicians should consider additional ultrasound scanning where appropriate to monitor for restricted growth in such pregnancies.

Item Type: Journal Article
Divisions: Faculty of Medicine > Warwick Medical School > Biomedical Sciences
Faculty of Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Journal or Publication Title: BMJ Global Health
Publisher: BMJ Publishing Group
ISSN: 2059-7908
Official Date: 28 November 2017
Dates:
DateEvent
28 November 2017Published
29 September 2017Accepted
Volume: 2
Number: 4
Article Number: e000377
DOI: 10.1136/bmjgh-2017-000377
Status: Peer Reviewed
Publication Status: Published
Publisher Statement: ** From Europe PMC via Jisc Publications Router. ** Licence for this article: cc by-nc
Access rights to Published version: Open Access

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