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APHA Scientific Session and Event Listing

Karin M. Zinsmeister¹, Birgit Reime, ScD MPH², Carina Jacob¹, Beate Schuecking, MD³, and Paul Wenzlaff, MSc⁴. (1) Healthcare and Nursing, University of Applied Sciences at Fulda, Germany, Marquardstr. 35, Fulda, 36039, Germany, **49-0176-23533742, karin.zinsmeister@pg.fh-fulda.de, (2) Centre for Healthcare Innovation and Improvement, Child and Family Research Institute, E414A - 4480 Oak Street, Vancouver, BC V6H 3V4, Canada, (3) Vice-President, University of Osnabrueck, Albrechtstr. 28, Osnabrueck, 49069, Germany, (4) Physicians' Chamber of Lower Saxony, PB 4749, Hanover, 30047, Germany

The purpose of the study was to explore whether inadequate prenatal care is related to stillbirths among migrant women who gave birth in Germany. We compared the stillbirth rates of women characterized by adequate and inadequate prenatal care from different origins (Mediterranean, Eastern Europe, Middle East, Asia, Europe & North America, and others) to women of German nationality. We analysed perinatal data routinely collected during pregnancy and birth on singletons born in the federal state of Lower Saxony, Germany, in 1990, 1995, and 1999 (n=182,444). Chisquare-tests, bivariate and multivariable logistic regression models were performed. In crude analyses, inadequate prenatal care (OR=1.86, 95%-CI 1.52, 2.28), and origin from East Europe (OR=8.93, 95%-CI .8.29, 9.62), the Mediterranean (OR=4.76, 95%-CI 4.34, 5.21), the Middle East (OR=3.29, 95%-CI 3.03, 3.57), and Asia (OR=3.32, 95%-CI 2.77, 3.99) were related to stillbirths. In multivariable analyses, prenatal care was not related to stillbirths after adjustment for age, parity, smoking, inter-pregnancy interval, and employment status. After adjustment for these confounders, compared to German women with adequate prenatal care, women from Eastern Europe with adequate prenatal care (OR=1.74, 95%-CI 1.33, 2.29), women from the Middle East with adequate care (OR=1.98, 95%-CI 1.64, 2.39) and women from the Mediterranean with inadequate prenatal care (OR=3.00, 95%-CI 1.71, 5.26) were at higher risk for stillbirths. There are inconsistent patterns of relationships between stillbirths, country of origin, and prenatal care. Among women from the Mediterranean, improvements in utilization of prenatal care may be related to lower stillbirth rates.

Learning Objectives:

• 1. Recognize that prenatal care and some migrant nationalities are related to stillbirths in unadjusted analyses.
• 2. Consider confounders we measured in our study and discuss potential unmeasured confounders that may affect the association between prenatal care, nationality and stillbirths.
• 3. Discuss the level of relevance our findings from a non-randomized study may have for health professionals.

Keywords: Pregnancy Outcomes, Migrant Health

Presenting author's disclosure statement:

Not Answered