Does underutilization of prenatal care explain the excess risk for stillbirth among women with migration background in Germany?

Abstract:

OBJECTIVE:To explore the role of utilization of prenatal care on the risk for stillbirth among women with migration background in Germany by comparing stillbirth rates of women from different origins characterized by adequate and inadequate utilization of prenatal care to German women with adequate utilization of care. DESIGN:Retrospective cohort study. SETTING:Lower Saxony, Germany. POPULATION:Singletons born in 1990, 1995 and 1999 (n = 182,444). METHODS:We analyzed perinatal data collected by obstetricians and midwives prospectively during pregnancy and after birth. The Adequacy of Prenatal Care Utilization Index was applied. Chi-squared tests and bivariate and multivariable logistic regression models were used. MAIN OUTCOME MEASURES:Stillbirth rates. RESULTS:In crude analyses, inadequate utilization of prenatal care (OR = 1.86, 95% CI 1.52, 2.28), and origin from Central and Eastern Europe (OR = 2.05, 95% CI 1.63, 2.58), the Mediterranean (OR = 1.77, 95% CI 1.38, 2.65), the Middle East (OR = 2.63, 95% CI 2.24, 3.09) and other countries (OR = 1.79, 95% CI 1.10, 2.89) were related to stillbirths. After adjustment for age, parity, smoking, inter-pregnancy interval, employment status and year of observation, compared to Germans with adequate utilization of prenatal care, women with adequate utilization of care from Central and Eastern Europe (OR = 1.74, 95% CI 1.33, 2.29) and the Middle East (OR = 1.98, 95% CI 1.64, 2.39) and women with inadequate utilization of prenatal care from the Mediterranean (OR = 3.00, 95% CI 1.71, 5.26) were at higher risk for stillbirths. CONCLUSION:There are inconsistent relation patterns between stillbirth, area of origin and utilization of prenatal care. Among women from the Mediterranean, increasing utilization of prenatal care may result in lower stillbirth rates.

authors

Reime B,Lindwedel U,Ertl KM,Jacob C,Schücking B,Wenzlaff P

doi

10.3109/00016340903295584

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

1276-83

issue

11

eissn

0001-6349

issn

1600-0412

pii

10.3109/00016340903295584

journal_volume

88

pub_type

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