The Outcomes of Pregnancy Among Imprisoned Women: A Systematic Review

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Women are a small but rapidly increasing minority of the nine million people imprisoned worldwide.1This increase has consistently been seen in a number of countries. In the United States there are now nearly 100,000 women in prison, an increase of 42% since 1995, and the number of women imprisoned in England and Wales has risen almost threefold over the past decade. Most of these women will be of childbearing age and an estimated 6% of imprisoned women are pregnant. Imprisoned pregnant women constitute an important obstetric group who differ from the general population and are a high risk group. They are more likely to come from socially deprived backgrounds and are more likely to smoke, drink alcohol to excess and abuse illegal drugs than the general population. Obviously this has implications for maternal health, but the extensive research on the intrauterine environment and links with disease in later life suggest that this also has important health implications for the next generation.

Given the background of many of these women, their increasing numbers and the importance of the environment not just for the mother's health but the future health of her baby, the effects of imprisonment on pregnancy outcomes are of considerable public health significance. There have been conflicting reports as to whether imprisonment has beneficial or deleterious effects on pregnancy outcomes. The objective of this study was to investigate the association between maternal imprisonment during pregnancy and perinatal outcomes through a systematic review of the literature.

Objective:  To investigate the association between maternal imprisonment during pregnancy and perinatal outcomes.

Methods:  Two reviewers extracted the data independently according to a fixed protocol. Studies were included if they were cohort or case–control studies with women identified as being imprisoned at any point during pregnancy and if they included a comparison group of women who had not been imprisoned. Case series without a comparison group of women who were not imprisoned were excluded, as were studies that did not include information on the pre-specified outcomes.

Main outcome measures:  Perinatal or infant death, stillbirth, preterm delivery, low birthweight, fetal anomalies and use of breast milk substitutes.

Results:  Of 28 relevant papers, 10 met the inclusion criteria, involving 1960 imprisoned pregnant women and 10,858 controls. There were significant differences in results between studies comparing imprisoned women with population controls and those making comparisons with disadvantaged control women. Imprisoned women are more likely to deliver prematurely and have a low birthweight baby than population control women. However, when compared with a similarly disadvantaged group, imprisoned woman are less likely to have a stillbirth or low birthweight baby, suggesting imprisonment may have a beneficial effect.

Conclusions:  Particular perinatal outcomes appear to be improved in imprisoned women compared with similarly disadvantaged women. Imprisonment of the mother has a beneficial effect on the birthweight of her baby.

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References:

Knight M, Plugge E. BJOG. 2005 Nov;112(11):1467-74.