PERINATAL DEATH IN ETHNIC-MINORITIES IN THE NETHERLANDS

Objectives-To investigate differences in perinatal death rate and asso ciated obstetric risk factors between ethnic groups in the Netherlands . Design-Retrospective cohort study based on the 1990-1993 birth cohor ts in the National Obstetric Registry. Subjects-569 743 births of whic h 85 527 were for women belonging to ethnic minorities. Main outcome m easures-Perinatal death occurring between 16th week of pregnancy and 2 4 hours after birth. Method-Bivariate and multivariate analysis of per inatal death rate per ethnic group. A total of 42 282 women living in the three main cities of the Netherlands were classified on the basis of postal code districts into four socioeconomic (SES) classes for ana lysis of the relation between SES, perinatal death, and preterm birth. Results-Black mothers had the highest perinatal death rate compared w ith indigenous Dutch (odds ratio 2.2, 95%CI 1.9, 2.4) followed by a gr oup ''others'', consisting of women of mixed or unknown ethnicity (odd s ratio 1.8, 95%CI 1.5, 2.0), Hindustani (odds ratio 1.4, 95%CI 1.2, 1 .6), and Mediterraneans (odds ratio 1.3, 95%CI 1.2, 1.4). Asians (excl uding West Indian Asians) and non-Dutch Europeans did not have higher rates than Dutch women. The increased rates of black and Hindustani wo men could be explained fully and that of the group ''others'' partiall y by higher rates of preterm birth. Controlling for age and parity low ered the odds ratio of the Medliterraneans slightly. The risk of ethni city was independent of SES. Conclusion-Ethnic minorities in the Nethe rlands except immigrants from Asia and other European countries have h igher rates of perinatal death than indigenous Dutch women. With a two fold increase, black women had the highest rate, which was related to an equally large increased rate of preterm birth.