Increased risk of severe maternal morbidity (near‐miss) among immigrant women in Sweden: a population register‐based study

Objective To determine if immigrant women from low‐, middle‐ and high‐income countries have an increased risk of severe maternal morbidity (near‐miss) when they deliver in Sweden. Design Population register‐based study. Setting Nationwide study including all singleton deliveries (≥28 weeks of gestation) between 1998 and 2007. Population Women with a near‐miss event; all women with a singleton delivery ≥28 weeks of gestation during the same period acted as reference group. Methods Near‐miss was defined by a combined clinical and management approach with use of International Classification of Diseases, 10th revision codes for severe maternal morbidity. A woman's country of origin was designated as low‐, middle‐ or high‐income according to the World Bank Classification of 2009. Unconditional logistic regression models were used in the analysis. Main outcome measures Maternal near‐miss frequencies per 1000 deliveries and odds ratios with 95% confidence intervals. Results There were 914 474 deliveries during the study period and 2655 near‐misses (2.9 per 1000 deliveries). In comparison to Swedish‐born women, those from low‐income countries had an increased risk of near‐miss (odds ratio 2.3, 95% confidence interval 1.9–2.8) that was significant in all morbidity groups except for cardiovascular diseases and sepsis. Women from middle‐ and high‐income countries showed no increased risk of near‐miss. Conclusions Women from low‐income countries have an increased risk of maternal near‐miss morbidity compared with women born in Sweden. Although the rate is low it should alert healthcare providers.