Decreasing trend in preterm birth and perinatal mortality, do disparities also decline?

Abstract

Background: In the Netherlands, several initiatives started after the publication of the PERISTAT findings that showed the perinatal mortality risk was higher than in other European countries. The objective of this study is 1) to report recent trends in perinatal mortality and in intermediate risk groups (preterm birth, congenital anomalies and small for gestational age (SGA)), 2) describing perinatal mortality risk among children born preterm, with congenital anomalies or SGA, and born in maternal high risk groups (parity, age, ethnicity and socioeconomic status (SES)). Methods: A nationwide cohort study in the Netherlands among 996,423 singleton births in 2010-2015 with a gestational age between 24.0 and 42.6 weeks. Trend tests, univariate and multivariable logistic regression analyses were used. We did separate analyses for gestational age subgroups and line of care. Results: The perinatal mortality rate was 5.0 per 1000 and it decreased significantly from 5.6 in 2010 to 4.6 per 1000 in 2015. Preterm birth significantly declined (6.1% in 2010 to 5.6% in 2015). Analysis by gestational age groups showed that the largest decline in perinatal mortality of 32% was seen at 24-27 weeks of gestation where the risk declined from 497 to 339 per 1000. At term, the decline was 23% from 2.2 to 1.7 per 1000. The smallest decline was 3% between 32 and 36 weeks. In children with preterm birth, congenital anomalies or SGA, the perinatal mortality risk significantly declined. Main risk factors for perinatal mortality were African ethnicity (adjusted odds ratio (aOR) 2.1 95%CI [1.9-2.4]), maternal age ≥ 40 years (aOR1.9 95%CI [1.7-2.2]) and parity 2 + (aOR 1.4 95%CI [1.3-1.5]). Among the (post)term born neonates, there was no significant decline in perinatal mortality in women with low age, low or high SES, non-Western ethnicity and among women who started or delivered under primary care. Conclusions: There is a decline in preterm birth and in perinatal mortality between 2010 and 2015. The decline in perinatal mortality is both in stillbirths and in neonatal mortality, most prominently among 24-27 weeks and among (post)term births. A possible future target could be deliveries among 32-36 weeks, women with high maternal age or non-Western ethnicity.

Ethnic variation in causes of stillbirth in high‐income countries: A systematic review and meta‐analysis

“…In our review, we built upon this foundation by investigating ethnic variation of causes of stillbirth in high‐income countries. While perinatal outcomes in some ethnic minority groups appear to have improved over time, disparities in stillbirth rates based on ethnicity continue to persist in the majority of reported cases 7–9,34,36,39,40,49–59 . Ethnicities with the largest sample sizes (Caucasian, African and Hispanic) overall showed similar proportions in the causes of stillbirth.…”

“…While perinatal outcomes in some ethnic minority groups appear to have improved over time, disparities in stillbirth rates based on ethnicity continue to persist in the majority of reported cases. [7][8][9]34,36,39,40,[49][50][51][52][53][54][55][56][57][58][59] Ethnicities with the largest sample sizes (Caucasian, African and Hispanic) overall showed similar proportions in the causes of stillbirth. Compared to non-Indigenous Australians, Indigenous…”

Lessons learned in cases of late preterm mortality in the Netherlands: Results from nationwide perinatal audits, a mixed method study

“…Ravelli et al [25] published about a decreasing trend in preterm birth, perinatal mortality and disparities in the Netherlands. Within their interpretation and clinical implications they refer to the introduction of nationwide perinatal audits in the Netherlands.…”

“…Within their interpretation and clinical implications they refer to the introduction of nationwide perinatal audits in the Netherlands. The authors stated that the audit resulted in the description of improvable factors in relation to death and recommended better care management, cooperation, documentation and guidelines, ready for implementation [25] . This is in line with our findings.…”

A Regionalization Model to Increase Equity of Access to Perinatal Care Services

“…Several papers investigated the effect of accessibility and travel time on healthcare outcomes in different cases like prenatal centers 10-12, , trauma centers 13 ,vaccine centers 14 , HIV centers 15 , and cardiovascular centers 16 . Some studies determined the effective criteria to reduce neonatal mortality [17][18][19][20] . Other like Kanter et al 21 developed the useful criteria to analyze regional hospital services to increase equity in access.…”