title: Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007.
abstract: BACKGROUND
  Stillbirth is a sensitive indicator for access to, and quality of health care and social services in a society. If a particular population group e.g. migrants experiences higher rates of stillbirth, this might be an indication of social deprivation or barriers to health care. This study examines differences in risk of stillbirth for women of different regions of origin compared to women from Germany in order to identify high risk groups/target groups for prevention strategies.
  
  
  METHODS
  We used the BQS dataset routinely compiled to examine perinatal outcomes in Germany nationwide. Participation of hospitals and completeness of data has been about 98% in recent years. Data on all live births and stillbirths were obtained for the period 2004 to 2007 (N = 2,670,048). We calculated crude and stratified mortality rates as well as corresponding relative mortality risks.
  
  
  RESULTS
  A significantly elevated stillbirth rate was found for women from the Middle East and North Africa (incl. Turkey) (RR 1.34, CI 1.22-1.55). The risk was slightly attenuated for low SES. An elevated risk was also found for women from Asia (RR 1.18, CI 1.02-1.65) and from Mediterranean countries (RR 1.14, CI 0.93-1.28). No considerable differences either in use and timing of antenatal care or preterm birth and low birthweight were observed between migrant and non-migrant women. After stratification for light for gestational age, the relative risk of stillbirth for women from the Middle East/North Africa increased to 1.63 (95% CI 1.25-2.13). When adjusted for preterm births with low birthweight, women from Eastern Europe and the Middle East/North Africa experienced a 26% (43%) higher risk compared with women from Germany.
  
  
  CONCLUSIONS
  We found differences in risk of stillbirth among women from Middle East/North Africa, especially in association with low SES and low birthweight for gestational age. Our findings suggest a need for developing and evaluating socially and culturally sensitive health promotion and prevention programmes for this group. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with migrant backgrounds.
authors.affiliation: Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, PO Box 10 01 31, D-33501 Bielefeld, Germany. reeske@bips.uni-bremen.de
authors.forename: Anna
authors.initials: A
authors.lastname: Reeske
authors.forename: Marcus
authors.initials: M
authors.lastname: Kutschmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
authors.forename: Jacob
authors.initials: J
authors.lastname: Spallek
mesh_terms: D000328:Adult; D000352:Africa, Northern / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D015438:Health Behavior / Q000208:ethnology; D054624:Health Status Disparities; D006801:Humans; D007226:Infant Mortality / Q000208:ethnology*; D007231:Infant, Newborn; D016015:Logistic Models; D008877:Middle East / Q000208:ethnology; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D011256:Pregnancy Outcome / Q000208:ethnology; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D050497:Stillbirth / Q000208:ethnology*; D055815:Young Adult