Peer-reviewed article
Cohort Profile: the SMRU Refugee and Migrant Pregnancy Study in Western Thailand and Eastern Myanmar.
McGready R, J White N, Nosten FH, SMRU Refugee and Migrant Pregnancy Study Collaborators ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This cohort profile describes a 38-year pregnancy study of refugee and migrant women in Thailand and Myanmar, following nearly 95,000 pregnancies from antenatal care through childbirth. The study found a maternal mortality rate of 176 per 100,000 livebirths and generated evidence on malaria treatment, infectious diseases, and malnutrition in pregnancy among marginalised populations. Findings led to changes in WHO treatment guidelines and improved maternal-child health practices in low-income settings.
Key points
- Maternal mortality rate of 176 per 100,000 livebirths among refugee and migrant women (120 deaths from 68,024 livebirths)
- Mean maternal height of 151.4 cm raises questions about appropriateness of pregnancy guidelines developed for taller populations
- Research on malaria in pregnancy led to changes in World Health Organisation Malaria Treatment Guidelines
- Double burden of malnutrition and infectious disease risk documented in refugee and migrant communities
- Embedded observational and clinical trials provided evidence on optimisation of malaria treatment and emerging non-communicable diseases
Limitations
This is a cohort profile describing data collection methods and summary findings rather than a detailed analysis. The document does not provide breakdown of specific interventions tested, comparison groups, or detailed statistical outcomes needed for full intervention evaluation.
Abstract
Background Marginalised populations face significant health risks in pregnancy with reduced access to preventive and life-saving services due to conflict and migration. Infectious disease risk is high and the double burden of malnutrition increases risk from non-communicable disease although only weak epidemiological data supports this in refugees and migrant communities. This manuscript describes the SMRU Refugee and Migrant Pregnancy Cohort commencing nearly 40 years ago, established in response to the very high rate of Plasmodium falciparum maternal mortality in refugee camps on the Thailand Myanmar border Methods Pregnant women who registered to antenatal care clinics of the Shoklo Malaria Research Unit from 1986 to 2024 living in marginalised communities of refugee and migrants were the eligible population. Pregnancies were prospectively followed from enrolment through to childbirth. Types of data include: 1) medical and obstetric records including patient characteristics, pregnancy progress and birth outcomes and 2) investigations (such as HIV). Results Among 94,645 pregnancies maternal mortality was 176 per 100,000 livebirths (120/68,024). Embedded cohorts included observational and clinical trials, providing evidence on the optimisation of treatment of malaria in pregnancy and on the rapid changes towards non-communicable diseases in refugees and migrants. Low mean height (151.4 cm), well below European and American populations from which the majority of guidelines have been created, questions appropriateness, such as gestational weight gain in pregnancy. A broad scope of research findings including tropical infections impacting pregnancy outcomes, mental health and suicide, a shared platform of "-omics" of Karen and Burmese women from first trimester, and practice of care in low-income settings have emerged and been shared. Conclusions The SMRU Refugee and Migrant Pregnancy Cohort findings have had significant local and international impact including changing the World Health Organisation Malaria Treatment Guidelines in pregnancy; and establishing a range of guidelines and tools improving maternal-child health practices.