Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden

Abstract

Background: The aim of the study was to investigate whether the maternal country of origin affected the risk for perinatal mortality and to determine its relationship to risk factors.

Methods: A study of 15,639 deliveries in Malmö, Sweden. Data regarding demographic factors, life-style and perinatal risk factors, together with data pertaining to outcome was obtained from the Malmö database and the Swedish Medical Birth Register.

Results: Perinatal mortality was increased among infants to women of Foreign origin as compared to those delivered by women of Swedish origin (OR 1.5, CI 1.0-2.2). Even after adjustments for maternal background and risk factors (diabetes, anemia, pre-eclampsia, placental abruption and small-for-gestational age), the increased risk of perinatal mortality among women of Foreign origin remained statistically significant. Women from sub-Saharan Africa, comprising 7.3% of all immigrants, differed from all other subgroups of women of foreign origin by having a higher risk of adverse outcome (small-for-gestational age OR 1.9, CI 1.0-3.6, neonatal distress OR 2.7, CI 5.1-4.8 and perinatal mortality OR 4.3, CI 2.1-8.6).

Conclusions: Women of foreign origin, especially from sub-Saharan Africa, have a higher risk of perinatal mortality than native Swedish women. The differences in mortality could not be explained by risk factors. The results suggest that women and newborns from sub-Saharan Africa should be given more intense surveillance on all levels of perinatal care in order to reduce perinatal mortality.