Maternal and neonatal outcomes in a cohort of pregnant women during conflict, Gaza Strip.

Objective: To assess the impact of conflict on maternal and neonatal mortality and health-care utilization among pregnant refugee women in the Gaza Strip. Methods: The study involved data on pregnancy outcomes for 17 713 refugee women in the Gaza Strip who were pregnant on 8 October 2023 and received antenatal care from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). We obtained data from UNRWA's electronic health records, an UNRWA phone survey and the Palestinian Ministry of Health's lists of deaths for October 2023 to June 2024. Findings: Overall, 168 maternal deaths were identified, yielding a pregnancy-related mortality ratio of 948 per 100 000 pregnancies compared to a maternal mortality ratio of 30 per 100 000 live births before the conflict. The pattern of age-specific, pregnancy-related deaths suggested that most were trauma-related. The stillbirth rate among women with known pregnancy outcomes was 10.3 per 1000 births compared with 6.0 per 1000 before the conflict, and the neonatal mortality rate was 9.4 per 1000 live births compared with 6.6 per 1000. The preterm birth rate was also higher, at 13.6% versus 9.7% before the conflict. Although most deliveries (97.3%) remained facility-based, there was a shift from government to nongovernmental organization facilities. Conclusion: The conflict in the Gaza Strip was associated with substantial increases in maternal and neonatal mortality and preterm births. Utilization of health services remained high, but delivery locations shifted to lower-level facilities and hospital stays shortened, raising concerns about the quality of care.