title: Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study.
abstract: OBJECTIVE
  To determine if immigrant women from low-, middle- and high-income countries have an increased risk of severe maternal morbidity (near-miss) when they deliver in Sweden.
  
  
  METHODS
  Population register-based study.
  
  
  METHODS
  Nationwide study including all singleton deliveries (≥28 weeks of gestation) between 1998 and 2007.
  
  
  METHODS
  Women with a near-miss event; all women with a singleton delivery ≥28 weeks of gestation during the same period acted as reference group.
  
  
  METHODS
  Near-miss was defined by a combined clinical and management approach with use of International Classification of Diseases, 10th revision codes for severe maternal morbidity. A woman's country of origin was designated as low-, middle- or high-income according to the World Bank Classification of 2009. Unconditional logistic regression models were used in the analysis.
  
  
  METHODS
  Maternal near-miss frequencies per 1000 deliveries and odds ratios with 95% confidence intervals.
  
  
  RESULTS
  There were 914 474 deliveries during the study period and 2655 near-misses (2.9 per 1000 deliveries). In comparison to Swedish-born women, those from low-income countries had an increased risk of near-miss (odds ratio 2.3, 95% confidence interval 1.9-2.8) that was significant in all morbidity groups except for cardiovascular diseases and sepsis. Women from middle- and high-income countries showed no increased risk of near-miss.
  
  
  CONCLUSIONS
  Women from low-income countries have an increased risk of maternal near-miss morbidity compared with women born in Sweden. Although the rate is low it should alert healthcare providers.
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health, Uppsala, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wahlberg
authors.forename: M
authors.initials: M
authors.lastname: Rööst
authors.forename: B
authors.initials: B
authors.lastname: Haglund
authors.forename: U
authors.initials: U
authors.lastname: Högberg
authors.forename: B
authors.initials: B
authors.lastname: Essén
mesh_terms: D000328:Adult; D003906:Developing Countries; D004522:Educational Status; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012042:Registries; D012306:Risk; D013548:Sweden
keywords: Immigration; maternal near-miss; severe maternal morbidity