title: Maternal near-miss among women with a migrant background in Germany.
abstract: OBJECTIVE
  To examine the association between region of origin and severe illness bringing a mother close to death (near-miss).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Maternity units in Lower Saxony, Germany.
  
  
  METHODS
  441 199 mothers of singleton newborns in 2001-2007.
  
  
  METHODS
  Using chi-squared tests, bivariate and multivariable logistic regression we examined the association between maternal region of origin and near-miss outcomes with prospectively collected perinatal data up to seven days postpartum.
  
  
  METHODS
  Hysterectomy, hemorrhage, eclampsia and sepsis rates.
  
  
  RESULTS
  Eclampsia was not associated with region of origin. Compared to women from Germany, women from the Middle East (OR 2.24; 95%CI 1.60-3.12) and Africa/Latin America/other countries (OR 2.17; 95%CI 1.15-4.07) had higher risks of sepsis. Women from Asia (OR 3.37; 95%CI 1.66-6.83) and from Africa/Latin America/other countries had higher risks of hysterectomy (OR 2.65; 95%CI 1.36-5.17). Compared to German women, the risk of hemorrhage was higher among women from Asia (OR 1.55; 95%CI 1.19-2.01) and lower among women from the Middle East (OR 0.66, 95%CI 0.55-0.78). Adjusting for maternal age, parity, occupation, partner status, smoking, obesity, prenatal care, chronic conditions and infertility showed no association between country of origin and risk of sepsis.
  
  
  CONCLUSIONS
  Region of origin was a strong predictor for near-miss among women from the Middle East, Asia and Africa/Latin America/other countries. Confounders mostly did not explain the higher risks for maternal near-miss in these groups of origin. Clinical studies and audits are required to examine the underlying causes for these risks.
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany. reime@bnitm.de
authors.forename: Birgit
authors.initials: B
authors.lastname: Reime
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Janssen
authors.forename: Lily
authors.initials: L
authors.lastname: Farris
authors.forename: Theda
authors.initials: T
authors.lastname: Borde
authors.forename: Claudia
authors.initials: C
authors.lastname: Hellmers
authors.forename: Hellen
authors.initials: H
authors.lastname: Myezwa
authors.forename: Paul
authors.initials: P
authors.lastname: Wenzlaff
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004461:Eclampsia / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D016015:Logistic Models; D008423:Maternal Age; D009765:Obesity / Q000453:epidemiology / Q000208:ethnology; D009790:Occupations; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000208:ethnology*; D011295:Prenatal Care; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000208:ethnology; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology; D014171:Transients and Migrants; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000208:ethnology