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Although women make up only a small proportion of the 9 million people imprisoned worldwide, their numbers are increasing rapidly and consistently across a number of countries. For example, 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. This implies that in England and Wales alone there are about 240 pregnant women in prison at any one time, and in the United States of America over 6,000.
These women constitute an important obstetric group about whom relatively little is known. Available evidence suggests that they are more likely to come from socially deprived backgrounds and to smoke, drink alcohol to excess and abuse illegal drugs than the general population. However, estimates of the prevalence of these risk behaviors in this population vary. These factors may affect both the health of the women themselves and also their offspring and are therefore of considerable public health significance. It is important to recognize these factors in order to allow appropriate planning of future services for this increasing number of women. The objective of this study therefore was to identify the risk factors associated with adverse pregnancy outcome present in imprisoned women through a systematic review of the literature.
Background
Imprisoned pregnant women constitute an important obstetric group about whom relatively little is known. This systematic review was conducted to identify the risk factors associated with adverse pregnancy outcome present in this group of women.
Methods
The review was conducted according to a prespecified protocol. Studies of any design were included if they described information on any of the pre-specified risk factors. We calculated the results as summary percentages or odds ratios where data was available on both cases and population controls.
Results
The search strategy identified 27 relevant papers of which 13 met the inclusion criteria, involving 1504 imprisoned pregnant women and 4571 population control women. Imprisoned women are more likely to be single, from an ethnic minority, and not to have completed high school. They are more likely to have a medical problem which could affect the pregnancy outcome and yet less likely to receive adequate antenatal care. They are also more likely to smoke, drink alcohol to excess and take illegal drugs.
Conclusion
Imprisoned women are clearly a high risk obstetric group. These findings have important implications for the provision of care to this important group of women.
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References:
Knight M, Plugge E. BMC Public Health. 2005 Oct 17; 5:111.
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