Disparities in maternal and fetal health among ethnogeographic groups-a retrospective cohort study of 30,000 women from a middle eastern multiethnic maternity population.

Abstract

Objectives: Maternal ethnogeographic origins and ancestry can influence perinatal health. This study evaluated the impact of nationalities grouped into geographic categories on maternal and neonatal outcomes.

Study design: The study employed a retrospective birth cohort design.

Methods: A total of 30,667 pregnant women and their neonates born at more than 24 weeks' gestational age in secondary and tertiary government maternity hospitals in Qatar were included. Data were extracted from a preexisting maternity registry. Women were classified into seven ethnogeographic groups based on internationally accepted classifications: Qatar group (QG), Gulf Cooperation Council (GCC), Arab Region (AR), South/Central Asia (SA), southeast Asian (SEA), African (AF), and European/American countries. Antenatal, intrapartum, and neonatal outcomes were compared between the groups using adjusted multivariable regression models with QG as the baseline.

Results: Participants represented 124 countries, with the majority from AR (37.6%). After Qatar (23.7%), the most represented countries were Egypt (12.3%) and India (11.6%). Gestational diabetes was most common in SA at 33.4% [adjusted odds ratio (aOR)=1.56, confidence intervals (CI) = 1.44-1.68; p < 0.0001], whereas SEA had higher odds of preeclampsia (aOR=2.50, CI = 1.86-3.36; p < 0.0001) and postpartum hemorrhage (aOR=1.88, CI = 1.55-2.28; p < 0.0001). Postdated pregnancy was more frequent in AF (aOR=2.34, CI = 1.85-3.0; p < 0.0001), while preterm birth rates were similar across groups. Vaginal birth after cesarean was highest in GCC (42.1%) and lowest in SEA and Africa (19%). Neonatal intensive care admission among term babies was similar across groups. No clinically relevant differences between groups were observed for rare neonatal outcomes such as stillbirth, neonatal death, or anomalies.

Conclusion: Clinically relevant differences in pregnancy outcomes exist among nationality groups, potentially attributable to ethnicity, genetic susceptibility, and potential socioeconomic factors. Understanding these differences is essential for adequate risk assessment, and further genetic and anthropological studies are warranted to confirm these findings.