Maternal near-miss among women with a migrant background in Germany.

Objective: To examine the association between region of origin and severe illness bringing a mother close to death (near-miss).

Design: Retrospective cohort study.

Setting: Maternity units in Lower Saxony, Germany.

Population: 441 199 mothers of singleton newborns in 2001-2007.

Methods: Using chi-squared tests, bivariate and multivariable logistic regression we examined the association between maternal region of origin and near-miss outcomes with prospectively collected perinatal data up to seven days postpartum.

Main Outcome Measures: Hysterectomy, hemorrhage, eclampsia and sepsis rates.

Results: Eclampsia was not associated with region of origin. Compared to women from Germany, women from the Middle East (OR 2.24; 95%CI 1.60-3.12) and Africa/Latin America/other countries (OR 2.17; 95%CI 1.15-4.07) had higher risks of sepsis. Women from Asia (OR 3.37; 95%CI 1.66-6.83) and from Africa/Latin America/other countries had higher risks of hysterectomy (OR 2.65; 95%CI 1.36-5.17). Compared to German women, the risk of hemorrhage was higher among women from Asia (OR 1.55; 95%CI 1.19-2.01) and lower among women from the Middle East (OR 0.66, 95%CI 0.55-0.78). Adjusting for maternal age, parity, occupation, partner status, smoking, obesity, prenatal care, chronic conditions and infertility showed no association between country of origin and risk of sepsis.

Conclusion: Region of origin was a strong predictor for near-miss among women from the Middle East, Asia and Africa/Latin America/other countries. Confounders mostly did not explain the higher risks for maternal near-miss in these groups of origin. Clinical studies and audits are required to examine the underlying causes for these risks.