Objective. To explore the role of utilization of prenatal care on the risk for stillbirth among women with migration background in Germany by comparing stillbirth rates of women from different origins characterized by adequate and inadequate utilization of prenatal care to German women with adequate utilization of care. Design. Retrospective cohort study. Setting. Lower Saxony, Germany. Population. Singletons born in 1990, 1995 and 1999 (n 182,444). Methods. We analyzed perinatal data collected by obstetricians and midwives prospectively during pregnancy and after birth. The Adequacy of Prenatal Care Utilization Index was applied. Chi-squared tests and bivariate and multivariable logistic regression models were used. Main outcome measures. Stillbirth rates. Results. In crude analyses, inadequate utilization of prenatal care (OR 1.86, 95% CI 1.52, 2.28), and origin from Central and Eastern Europe (OR 2.05, 95% CI 1.63, 2.58), the Mediterranean (OR 1.77, 95% CI 1.38, 2.65), the Middle East (OR 2.63, 95% CI 2.24, 3.09) and other countries (OR 1.79, 95% CI 1.10, 2.89) were related to stillbirths. After adjustment for age, parity, smoking, inter-pregnancy interval, employment status and year of observation, compared to Germans with adequate utilization of prenatal care, women with adequate utilization of care from Central and Eastern Europe (OR 1.74, 95% CI 1.33, 2.29) and the Middle East (OR 1.98, 95% CI 1.64, 2.39) and women with inadequate utilization of prenatal care from the Mediterranean (OR 3.00, 95% CI 1.71, 5.26) were at higher risk for stillbirths. Conclusion. There are inconsistent relation patterns between stillbirth, area of origin and utilization of prenatal care. Among women from the Mediterranean, increasing utilization of prenatal care may result in lower stillbirth rates. © 2009 Informa UK Ltd.

Prenatal care utilization Migrants Germany stillbirths

Germany Mediterranean Region Europe, Eastern prenatal care Europe human Cohort Studies Middle East Cigarette Smoking priority journal Eastern Europe Logistic Models medical practice Young Adult Adequacy of Prenatal Care Utilization Index school child Humans Adolescent Infant, Newborn Emigrants and Immigrants female risk factor pregnancy prevalence scoring system Article Retrospective Studies health care utilization Southern Europe major clinical study adult migration midwife cohort analysis parity stillbirth retrospective study employment obstetrics Child