[Perinatal outcomes in the four largest cities and in deprived neighbourhoods in The Netherlands].
OBJECTIVE
To analyse the association between neighbourhood, ethnicity and adverse perinatal outcome in pregnant women from the 4 largest cities (Amsterdam, Rotterdam, The Hague and Utrecht; G4) and elsewhere in The Netherlands.


METHODS
Descriptive, retrospective.


METHODS
The perinatal outcome of 877,816 single pregnancies during the years 2002-2006, derived from The Netherlands Perinatal Registry, was analysed for the ethnicity (Western or non-Western) and the neighbourhood (deprived or not) of the pregnant women in the G4 and elsewhere in The Netherlands. Adverse perinatal outcome was defined as perinatal mortality, congenital abnormalities, intra-uterine growth restriction, preterm birth, Apgar score after 5 minutes < 7 and/or admission to a neonatal intensive-care unit.


RESULTS
The overall perinatal mortality rate was higher in the G4 than elsewhere in The Netherlands (11.1 per thousand versus 9.3 per thousand; p < 0.001; 95% confidence interval of the difference: 1.2-2.4 per thousand). The same was true for the sum of adverse perinatal outcomes (154.9 per thousand versus 138.9 per thousand). In the G4 the perinatal mortality among non-Western women was higher than among Western women (13.2 per thousand versus 9.5 per thousand). Residing in Dutch deprived neighbourhoods was associated with a higher perinatal mortality than outside deprived neighbourhoods (13.5 per thousand versus 9.3 per thousand). The relative risks of living in deprived neighbourhoods for adverse pregnancy outcomes are higher among Western than among non-Western women.


CONCLUSIONS
Pregnant women in the G4 have an increased risk ofadverse perinatal outcomes. The risks of residing in a deprived neighbourhood are even higher, especially among Western women. The findings are important for new strategies to improve perinatal outcomes.
de Graaf
J P
JP
Afd. Verloskunde en Vrouwenziekten, Erasmus MC-Centrum, Postbus 2040, 3000 CA Rotterdam.
Ravelli
A C J
AC
Wildschut
H I J
HI
Denktaş
S
S
Voorham
A J J
AJ
Bonsel
G J
GJ
Steegers
E A P
EA
D000328:Adult; D001034:Apgar Score; D002947:Cities; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000208:ethnology; D003710:Demography; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000208:ethnology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D009426:Netherlands / Q000453:epidemiology / Q000208:ethnology; D054238:Perinatal Mortality / Q000208:ethnology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology; D012189:Retrospective Studies; D055815:Young Adult