Obstetric Outcomes Among Women Evacuated From Conflict Zones: A Multicenter Retrospective Cohort Study

Background: Armed conflict-related evacuation may expose pregnant women to acute stress and disrupted care, and the specific obstetric consequences of evacuation remain poorly defined. This study evaluated outcomes among evacuated women. Methods: A retrospective cohort study was conducted using data from nine university-affiliated hospitals in Israel. Deliveries between October 7, 2023, and April 7, 2024, were included. Women who resided in government-designated evacuation zones formed the study group, whereas women from non-evacuated regions served as controls. Electronic medical records (EMRs) were reviewed and included maternal demographics, obstetric history, comorbidities, and obstetric and neonatal outcomes. Propensity score matching (1:3) was performed based on maternal age, socioeconomic status (SES), parity, and chronic comorbidities. Results: The total cohort included 14,290 deliveries, of which 321 (2.2%) occurred in evacuated zones. Evacuated women had higher rates of pregestational diabetes mellitus (PGDM), malignancy, lower SES, and were more often Jewish. In unadjusted analyses, late preterm birth (PTB) (34 to 36+6 weeks) was significantly more common among evacuated women (5.6% vs. 3.4%; odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.03–2.71; p = 0.038). In contrast, overall PTB and earlier PTB did not differ significantly between groups. Postpartum hemorrhage (PPH) was significantly lower in the evacuated group (1.6% vs. 4.4%; OR: 0.35, 95% CI: 0.14–0.84; p = 0.013). Other obstetric and neonatal outcomes did not differ significantly between groups. Following matching (287 evacuated vs. 861 controls), baseline characteristics were well balanced. The incidence of PPH remained significantly lower in the evacuated group (1.4% vs. 4.3%; OR: 0.31, 95% CI: 0.11–0.86; p = 0.027). Other obstetric and neonatal outcomes, including PTB, did not differ significantly between the two groups. Conclusions: Among women from evacuation zones, obstetric and neonatal outcomes did not differ significantly from those of non-evacuated women, except for a lower rate of PPH. These findings suggest that, despite acute stress and potential disruptions in care, evacuation itself was not associated with adverse obstetric outcomes, underscoring the resilience of maternity care systems during periods of conflict.