ObjectiveTo assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries.DesignCross-country comparative study of linked population-based databases.SettingProvincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden.PopulationAll immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995–2010).MethodsData was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI).Main outcome measuresPre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries).ResultsThere were 9 028 802 deliveries (3 031 399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest.ConclusionImmigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.

Objective To quantify how the changing stillbirth risk profile of women is affecting the interpretation of the stillbirth rate. Design A retrospective, population‐based cohort study from 1983 to 2018. Setting Victoria, Australia. Population A total of 2 419 923 births at ≥28 weeks of gestation. Methods Changes in maternal characteristics over time were assessed. A multivariable logistic regression model was developed for stillbirth, based on maternal characteristics in 1983–1987, and used to calculate individual predictive probabilities of stillbirth from the regression equation. The number of expected stillbirths per year as a result of the change in maternal demographics was then calculated, assuming no changes in care and in the associations between maternal characteristics and stillbirth over time. Main outcome measure Stillbirth. Results Compared with 1983–1987, there were more women in older age groups giving birth, more nulliparous women, more indigenous women and women born in Oceania, Asia and Africa, more multiple pregnancies and more women with pre‐existing diabetes in 2014–2018. Despite this, the rate of stillbirth fell from 5.42 per 1000 births in 1983 to 1.72 per 1000 births in 2018 (P < 0.001). Applying the multivariable logistic regression equation, derived from the 1983–87 data, to each year, had there been no changes in care or in the associations between maternal characteristics and stillbirth, the rate of stillbirth would have increased by 12%, from 4.94 per 1000 in 1983 to 5.54 per 1000 in 2018, as a result of the change in maternal characteristics. Conclusions Population rates of stillbirth are falling faster than is generally appreciated. Tweetable abstract Population reductions in stillbirth have been underestimated as a result of changing maternal characteristics.

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Background Breastfeeding is the optimal nutrition for babies, and its successful initiation is one of the aims of maternity care. This paper explores the association between aspects of intrapartum care and early breastfeeding problems. Methods Analysis of routinely-collected data on all births in Victoria, Australia in 2009. Comparison of proportions and multivariate logistic regression were performed. Results Of the 69,143 women who gave birth to term, liveborn babies, 96.3% initiated breastfeeding. 77.8% of the women who initiated breastfeeding gave the last feed before discharge entirely and directly from the breast. Women who experienced a number of interventions in labour and birth were more likely than others to have a problem with this. Oxytocin infusions to induce or augment labour (Relative Risk (RR) 1.26, 95% CI 1.2, 1.3), epidural analgesia (RR 1.36, 95% CI 1.3, 1.4), and caesarean section (RR 1.58, 95% CI 1.5, 1.6) were all associated with giving some expressed breastmilk or formula at the last feed before discharge. Term, breastfed babies whose mothers experienced these interventions were more likely to be given infant formula in hospital (oxytocin infusions (RR 1.18, 95% CI 1.1, 1.2), epidural analgesia (RR 1.30, 95% CI 1.26, 1.34), and caesarean section (RR 1.70, 95% CI 1.65, 1.75)). These relationships persisted after adjustment for parity, maternal BMI, age, public/private admission status, smoking during pregnancy and socio-economic status. Conclusions Common interventions in labour and birth are associated with early breastfeeding problems. Decisions about the risks and benefits of any given intervention should take this into account.