Maternal refugee status is associated with less favourable motor performance and behaviour in term infants referred to a neonatal ward: a cross-sectional study.

Abstract

Background: Anxiety and depression are highly prevalent among Syrian refugees. Anxiety and depression during pregnancy may impair infant neurodevelopment. This study evaluated whether potential maternal anxiety and depression in Syrian refugee and native Turkish mothers were associated with less favourable neonatal neurodevelopment.

Study design: Cross-sectional study.

Methods: Turkish (n = 64) and Syrian (n = 17) term-born infants (37-41 weeks' gestation) referred to a level II-III neonatal intensive care unit in Izmir were assessed shortly after birth (median 5 days) together with their mothers. The Test of Infant Motor Performance (TIMP) was the primary outcome measure. In addition, we evaluated crying behaviour during the TIMP-assessment and performed General Movements Assessment (GMA). Mothers completed Beck Anxiety and Beck Depression Inventories in their native languages. Univariate and multivariate statistics were applied.

Result: Perinatal social characteristics of both groups were similar. TIMP scores of Syrian infants were significantly lower than those of Turkish infants (45.53 (SD 7.10) vs. 51.59 (SD 8.59), respectively (p = 0.009)). Sixteen Turkish infants (25%) and ten Syrian infants (59%) had TIMP z-scores below - 1 SD (unadjusted OR = 1.27 (95%CI 1.06-1.54); adjusted OR = 1.30 (95%CI 1.05-1.61)). At TIMP-assessment's end, more Syrian infants cried (29%) compared to Turkish infants (8%; unadjusted OR 4.92 (95%CI 1.23-19.67). This association lost significance after adjustment (OR = 4.87; 95%CI 0.77-31.01). GMA ratings of both groups were similar (definitely abnormal Turkish infants (n = 5; 8%); Syrian infants (n = 1; 7%); unadjusted OR = 0.91 (95%CI 0.30-2.78); adjusted OR = 1.66 (95%CI 0.42-6.61)). Anxiety and depression scores of both mothers` groups were low (median anxiety scores of Syrian mothers 0, Turkish mothers 1; median depression scores of Syrian mothers 0, Turkish mothers 2.5). The low maternal anxiety and depression scores were not associated with the infants' TIMP scores.

Conclusions: Maternal refugee status was associated with less favourable neonatal motor performance, with about half of the Syrian refugee newborns having a TIMP score indicating the need for close monitoring of development and a potential need for early intervention. Motor performance was not associated with maternal reports of anxiety and depression. Nonetheless, the study suggests that the neurodevelopment of babies born to refugee mothers should be carefully monitored to enable early intervention whenever required.