Disparities in antenatal care utilization and stillbirth risk among women of other origin than high-income Western countries in Stockholm 2000–2020: A retrospective cohort study

Abstract

Introduction

Foreign-born women face a higher risk of adverse pregnancy outcomes, including stillbirth, compared to Swedish-born women, and this disparity cannot be fully explained by known risk factors. This study investigates differences in pregnancy-related health care by maternal origin and whether such differences may contribute to disparities in stillbirth risk.

Material and Methods

This was a retrospective cohort study including all singleton births in the Stockholm region between 2000 and 2020 (n = 518 792 births). Data from the National Medical Birth Register was linked to data from Statistics Sweden and the VAL databases using the personal identity number of the mother. Maternal and fetal characteristics, inpatient care occasions, length of hospital stay, outpatient visits, and antenatal care visits were compared between women divided by maternal origin, experiencing live births, and stillbirths. Regression models using a forward selection strategy were performed, adjusting for different potential mediators on the causal pathway from maternal country of origin to stillbirth.

Results

Among women with live births, those originating from Middle East/Northern Africa, sub-Saharan Africa, and South America had significantly higher proportions of inpatient care occasions than women originating from high-income Western Countries. Women with live births originating from other regions than high-income Western Countries had significantly less antenatal care visits, regardless of parity. Among women with stillbirths, women originating from sub-Saharan Africa had significantly more inpatient care occasions and fewer antenatal care visits than women originating from high-income Western Countries. After adjusting for maternal risk factors, SGA infants, socioeconomic factors, multiple inpatient care occasions, and few antenatal care visits during pregnancy, women from sub-Saharan Africa had a slightly elevated risk of stillbirth (aOR 1.29, 95% CI 1.00–1.66, p-value 0.047) compared to women from high-income Western Countries.

Conclusions

Women originating from other regions than high-income Western Countries, especially those from sub-Saharan Africa, attended fewer antenatal care visits and had more inpatient care occasions compared to women from high-income Western Countries. Reduced attendance in antenatal care could potentially be associated with their elevated stillbirth risk. Improving access to and participation in antenatal care should be prioritized to reduce disparities in stillbirth risk.