title: 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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Lower Saxony, Germany.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Centre for Healthcare Innovation and Improvement (CHII), British Columbia Child and Family Research Institute, Vancouver, B.C., Canada. birgit.reime@gmx.de
authors.forename: Birgit
authors.initials: B
authors.lastname: Reime
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lindwedel
authors.forename: Karin M
authors.initials: KM
authors.lastname: Ertl
authors.forename: Carina
authors.initials: C
authors.lastname: Jacob
authors.forename: Beate
authors.initials: B
authors.lastname: Schücking
authors.forename: Paul
authors.initials: P
authors.lastname: Wenzlaff
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D019083:Mediterranean Region / Q000208:ethnology; D008877:Middle East / Q000208:ethnology; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology* / Q000208:ethnology; D055815:Young Adult