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Background: Cultural factors are often mentioned as a possible explanation for the observed differences between immigrant populations compared to general populations with regards to COVID-19 disease burden and vaccination rates, but usually without any further exploration of what this entails. This paper aims to capture the thoughts of immigrants themselves and explore how they think culture may or may not have affected vaccination rates and health behavior during the pandemic. Methods: We performed qualitative interviews with 18 immigrants from Poland, Somalia and Sri Lanka living in Norway. Group interviews and individual interviews were transcribed and analyzed using systematic text condensation. Results: We identified four main themes the participants thought could influence spread of infection and vaccine hesitancy: cultural factors, transcultural factors, host society factors, and other personal factors. Social habits, religious traditions, attitudes towards and trust in the healthcare system, sense of community and societal duty were understood as cultural factors that influenced health behavior and vaccination hesitancy. However, different cultural factors could have varied impact on immigrants' behavior related to COVID-19 and possibly other health settings for different immigrant groups. In addition, we found examples of other factors related to being 'between cultures', and we found structural and socioeconomic factors not linked to culture. Conclusions: Our paper brings awareness to how rules and guidelines may hit harder and interfere more in the way of life in some communities than others. In the continued work towards equity in health promotion and healthcare services, policymakers ought to keep the existence of such cultural differences in mind, to be able to make policies well fitted to ensure good health and quality of life for all. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of adverse pregnancy outcomes between twin‐born and singleton‐born women. We also evaluated whether in utero exposure to pre‐eclampsia or preterm delivery affected adverse pregnancy outcomes in women's own pregnancies. Design: Population‐based cohort study. Setting: Medical Birth Registry of Norway 1967–2020. Population: 9184 twin‐born and 492 894 singleton‐born women during 1967–2005, with their later pregnancies registered during 1981–2020. Methods: Data from an individual's birth were linked to their later pregnancies. We used generalised linear models with log link binomial distribution to obtain exponentiated regression coefficients that estimated relative risks (RRs) with 95% confidence intervals (CIs) for associations between twin‐ or singleton‐born women and later adverse pregnancy outcomes. Main outcome measures: Pre‐eclampsia, preterm delivery or perinatal loss in twin‐born compared with singleton‐born women. Results: There was no increased risk for adverse outcomes in twin‐born compared with singleton‐born women: adjusted RRs for pre‐eclampsia were 1.00 (95% CI 0.93–1.09), for preterm delivery 0.96 (95% CI 0.90–1.02) and for perinatal loss 1.00 (95% CI 0.84–1.18). Compared with singleton‐born women exposed to pre‐eclampsia in utero, twin‐born women exposed to pre‐eclampsia had lower risk of adverse outcomes in their own pregnancies; the aRR for pre‐eclampsia was 0.73 (95% CI 0.58–0.91) and for preterm delivery was 0.71 (95% CI 0.56–0.90). Compared with preterm singleton‐born women, preterm twin‐born women did not differ in terms of risk of pre‐eclampsia (aRR 1.05, 95% CI 0.92–1.21) or perinatal loss (aRR 0.99, 95% CI 0.71–1.37) and had reduced risk of preterm delivery (RR 0.83, 95% CI 0.74–0.94). Conclusions: Twin‐born women did not differ from singleton‐born women in terms of risk of adverse pregnancy outcomes. Twin‐born women exposed to pre‐eclampsia in utero, had a lower risk of pre‐eclampsia and preterm delivery compared with singleton‐born women exposed to pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Background: Women with one lifetime singleton pregnancy have increased risk of cardiovascular disease (CVD) mortality compared with women who continue reproduction particularly if the pregnancy had complications. Women with twins have higher risk of pregnancy complications, but CVD mortality risk in women with twin pregnancies has not been fully described. Objectives: We estimated risk of long‐term CVD mortality in women with naturally conceived twins compared to women with singleton pregnancies, accounting for lifetime number of pregnancies and pregnancy complications. Methods: Using linked data from the Medical Birth Registry of Norway and the Norwegian Cause of Death Registry, we identified 974,892 women with first pregnancy registered between 1967 and 2013, followed to 2020. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for maternal CVD mortality were estimated by Cox regression for various reproductive history (exposure categories): (1) Only one twin pregnancy, (2) Only one singleton pregnancy, (3) Only two singleton pregnancies, (4) A first twin pregnancy and continued reproduction, (5) A first singleton pregnancy and twins in later reproduction and (6) Three singleton pregnancies (the referent group). Exposure categories were also stratified by pregnancy complications (pre‐eclampsia, preterm delivery or perinatal loss). Results: Women with one lifetime pregnancy, twin or singleton, had increased risk of CVD mortality (adjusted hazard [HR] 1.72, 95% confidence interval [CI] 1.21, 2.43 and aHR 1.92, 95% CI 1.78, 2.07, respectively), compared with the referent of three singleton pregnancies. The hazard ratios for CVD mortality among women with one lifetime pregnancy with any complication were 2.36 (95% CI 1.49, 3.71) and 3.56 (95% CI 3.12, 4.06) for twins and singletons, respectively. Conclusions: Women with only one pregnancy, twin or singleton, had increased long‐term CVD mortality, however highest in women with singletons. In addition, twin mothers who continued reproduction had similar CVD mortality compared to women with three singleton pregnancies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population Method Main Outcome Measures Results Conclusion The objective of this study is to assess associations between pregnancy complications and pregnancy‐associated maternal mortality (PAM) within 1 year after childbirth.Population‐based cohort study.Norway, 1967–2020.1 237 254 mothers with one or more singleton pregnancies registered in the Medical Birth Registry, 1967–2019 and followed in the Cause of Death Registry to 2020.Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for maternal education, age, year of first childbirth and chronic medical conditions.PAM by lifetime history of pregnancy complications: placental abruption, preeclampsia, preterm birth, perinatal death, small for gestational age (< 2.5 percentile), gestational diabetes and gestational hypertension.Crude OR for PAM was 4.24 (95% CI 3.53–5.10), if complications occurred in the last pregnancy, whereas 2.52 (2.08–3.06) if complications occurred in the first pregnancy, compared to mothers without complications in any pregnancy. Adjusted ORs for PAM when complications occurred in the last pregnancy were, for placental abruption 3.75 (1.20–11.72), preeclampsia: 4.42 (3.17–6.15), preterm birth: 4.32 (3.25–5.75), perinatal death: 24.18 (16.66–35.08), small for gestational age: 2.90 (1.85–4.54), gestational diabetes: 1.43 (0.63–3.25) and pregnancy hypertension: 2.05 (1.12–3.74) compared to mothers without complications. The OR for PAM increased slightly by increasing the number of complicated pregnancies but the trend was stronger for increasing number of complications in the last pregnancy (e.g., during 1999–2019: one complication; 4.14 [2.79–6.13], two complications; 11.50 [6.81–19.43]).Complications in the last pregnancy were more strongly associated with PAM than those in the first pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of adverse pregnancy outcomes between twin-born and singleton-born women. We also evaluated whether in utero exposure to pre-eclampsia or preterm delivery affected adverse pregnancy outcomes in women's own pregnancies., Design: Population-based cohort study., Setting: Medical Birth Registry of Norway 1967-2020., Population: 9184 twin-born and 492 894 singleton-born women during 1967-2005, with their later pregnancies registered during 1981-2020., Methods: Data from an individual's birth were linked to their later pregnancies. We used generalised linear models with log link binomial distribution to obtain exponentiated regression coefficients that estimated relative risks (RRs) with 95% confidence intervals (CIs) for associations between twin- or singleton-born women and later adverse pregnancy outcomes., Main Outcome Measures: Pre-eclampsia, preterm delivery or perinatal loss in twin-born compared with singleton-born women., Results: There was no increased risk for adverse outcomes in twin-born compared with singleton-born women: adjusted RRs for pre-eclampsia were 1.00 (95% CI 0.93-1.09), for preterm delivery 0.96 (95% CI 0.90-1.02) and for perinatal loss 1.00 (95% CI 0.84-1.18). Compared with singleton-born women exposed to pre-eclampsia in utero, twin-born women exposed to pre-eclampsia had lower risk of adverse outcomes in their own pregnancies; the aRR for pre-eclampsia was 0.73 (95% CI 0.58-0.91) and for preterm delivery was 0.71 (95% CI 0.56-0.90). Compared with preterm singleton-born women, preterm twin-born women did not differ in terms of risk of pre-eclampsia (aRR 1.05, 95% CI 0.92-1.21) or perinatal loss (aRR 0.99, 95% CI 0.71-1.37) and had reduced risk of preterm delivery (RR 0.83, 95% CI 0.74-0.94)., Conclusions: Twin-born women did not differ from singleton-born women in terms of risk of adverse pregnancy outcomes. Twin-born women exposed to pre-eclampsia in utero, had a lower risk of pre-eclampsia and preterm delivery compared with singleton-born women exposed to pre-eclampsia., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)