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-, middleand high-income countries have an increased risk of severe maternal morbidity (near-miss) when they deliver in Sweden.Design Population register-based study.Setting Nationwide study including all singleton deliveries (≥28 weeks of gestation) between 1998 and 2007.Population 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.Main outcome measures 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.Keywords Immigration, maternal near-miss, severe maternal morbidity.Please cite this paper as: Wahlberg Å , R€ o€ ost M, Haglund B, H€ ogberg U, Ess en B. Increased risk of severe maternal morbidity (near-miss) among immigrant women in Sweden: a population register-based study.

Maternal near‐miss at university hospitals with cesarean overuse: an incident case‐control study

“…The correlation between MNM and lack of insurance was a new finding in our settings, although prior studies indicate that adverse maternal outcomes are more likely among immigrants and socially disadvantaged women in high-income countries (23)(24)(25). Dissociation from the health system affects women's care-seeking behavior and timely access to medical attention and may thus be associated with MNM (26,27).…”

Maternal Origin and Risk of Neonatal and Maternal ICU Admission*

“…It is clear from prior work that preeclampsia is a major predictor of SAMM and maternal ICU admission (5,21,25). Upon restricting our sample to women with PIH, the aRR for maternal ICU admission was even more pronounced for women from the Caribbean (Fig.…”

“…Similar findings were observed in Germany for the outcome of severe acute maternal morbidity (SAMM) (20). In a Swedish study of 914,474 singleton deliveries, the rate of SAMM was 7.0 per 1,000 immigrant women from low-income countries (like that for maternal ICU among our immigrant countries at highest risk), versus 2.8 per 1,000 among women born in Sweden-an adjusted odds ratio (aOR) of 2.3 (95% CI, 1.9-2.8) (21). The leading risk factor for SAMM was preeclampsia (aOR, 3.0; 95% CI, 2.0-4.5).…”

Severe obstetric complications («near miss »): problems, search and solutions

“…О связи тяжелых материнских исходов и социаль-но-экономических факторов свидетельствуют иссле-дования, проведенные в высокоразвитых странах [33,45].…”

“…По сравнению с женщинами шведского происхождения у женщин-им-мигранток из стран с низким экономическим разви-тием был повышен риск NM. Женщины-иммигрантки из стран со средним и высоким уровнем экономиче-ского развития этого риска не имели [45].…”