Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden

Background The aim of the study was to investigate whether the maternal country of origin affected the risk for perinatal mortality and to determine its relationship to risk factors. Methods. A study of 15,639 deliveries in Malmo, Sweden. Data regarding demographic factors, life-style and perinatal risk factors, together with data pertaining to outcome was obtained from the Malmo database and the Swedish Medical Birth Register. Results. Perinatal mortality was increased among infants to women of Foreign origin as compared to those delivered by women of Swedish origin (OR 1.5, CI 1.0-2.2). Even after adjustments for maternal background and risk factors (diabetes, anemia, pre-eclampsia, placental abruption and small-for-gestational age), the increased risk of perinatal mortality among women of Foreign origin remained statistically significant. Women from sub-Saharan Africa, comprising 7.3% of all immigrants, differed from all other subgroups of women of foreign origin by having a higher risk of adverse outcome (small-for-gestational age OR 1.9, CI 1.0-3.6, neonatal distress OR 2.7, CI 5.1-4.8 and perinatal mortality OR 4.3, CI 2.1-8.6). Conclusions. Women of foreign origin, especially from sub-Saharan Africa, have a higher risk of perinatal mortality than native Swedish women. The differences in mortality could not be explained by risk factors. The results suggest that women and newborns from sub-Saharan Africa should be given more intense surveillance on all levels of perinatal care in order to reduce perinatal mortality.