Table_1_A scoping review of maternal health among resettled refugee women in the United States.docx

BackgroundGlobally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion.
MethodsElectronic databases were searched in PubMed, CINAHL, PsycINFO, and EMBASE from inception through July 2021. We included all peer-reviewed study designs; qualitative, quantitative, and mixed method if they reported on refugee women's perinatal health experiences and outcomes in the US.
ResultsA total of 2,288 records were identified, with 29 articles meeting the inclusion criteria. Refugee women tend to initiate prenatal care late and have fewer prenatal care visits compared to women born in the US. Some of them were reluctant to get obstetric interventions such as labor induction and cesarean delivery. Despite numerous risk factors, refugee women had generally better maternal health outcomes. Studies have also highlighted the importance of health care providers' cultural competency and sensitivity, as well as the potential role of community health workers as a bridge between refugee women and health care providers.
ConclusionsThe scoping review emphasizes the need for early prenatal care initiation and more frequent prenatal care visits among refugee women. Furthermore, more needs to be done to mitigate resistance to obstetric interventions and mistrust. The mechanism by which healthy migrant effects occur could be better understood, allowing protective factors to be maintained throughout the resettlement and acculturation process. The scoping review identifies critical gaps in the literature, such as the underrepresentation of different ethnic groups of refugee women in refugee maternal studies in the US. Since this invisibility may indicate unspoken and unaddressed needs, more attention should be paid to underrepresented and understudied groups of refugee women in order to achieve health equity for all.

背景
全球范围内，难民女性在妊娠与分娩期间仍面临更高的可预防性产科并发症相关生育风险，其部分诱因包括高昂的医疗费用、对医疗体系不熟悉、语言障碍以及歧视。然而，目前针对美国境内相关现有证据开展评估的学术文献仍较为匮乏。本范围综述（scoping review）梳理了针对美国境内已重新定居难民女性的产科健康相关学术文献，旨在明确现有文献中的知识空白，并明确未来产科健康促进的研究重点与方向。
方法
本研究检索了PubMed、CINAHL、PsycINFO以及EMBASE四大电子数据库，检索时限自建库起至2021年7月。纳入所有经同行评议的研究设计，包括定性研究、定量研究以及混合方法研究，只要其报道了美国境内难民女性的围产期健康体验与结局即可。
结果
本研究共检索到2288条文献记录，其中29篇符合纳入标准。与美国本土出生女性相比，难民女性往往更晚开始产前保健，且产前检查次数更少。部分难民女性不愿接受引产、剖宫产等产科干预措施。尽管存在诸多风险因素，难民女性的产科健康结局总体更优。相关研究还强调了医疗服务人员的文化胜任力与敏感度的重要性，以及社区卫生工作者作为难民女性与医疗服务人员之间沟通桥梁的潜在作用。
结论
本范围综述强调，需推动难民女性更早开始产前保健，并增加产前检查频次。此外，还需采取更多措施缓解难民女性对产科干预的抵触情绪与信任缺失问题。未来可进一步阐明健康移民效应的发生机制，从而在难民重新定居与文化适应的全过程中维持其健康保护因素。本范围综述还明确了现有文献中的关键空白，例如美国难民产科健康研究中不同族裔难民女性的样本代表性不足。由于这种样本缺失可能反映出未被言说且未得到满足的需求，因此需更多关注代表性不足、研究较少的难民女性群体，以实现全民健康公平。