Lundén Minna, Varli Ingela Hulthén, Kallner Helena Kopp, Åmark Hanna
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
BB S:t Göran, Capio S:t Göran Hospital, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2025 Jun;104(6):1070-1080. doi: 10.1111/aogs.15103. Epub 2025 Apr 1.
In Sweden, a higher incidence of stillbirth has been observed among women originating from sub-Saharan Africa and the Middle East. In this nationwide cohort of more than 2 million births, we assessed the risk factors for stillbirth among foreign-born women with the aim of understanding which mediators have the largest impact on the elevated risk of stillbirth.
This was a nationwide cohort study in Sweden including 2 300 391 births between 2000 and 2021. Data from the National Medical Birth Register were linked to data from Statistics Sweden using the personal identity number of the mother. Differences in maternal characteristics were analyzed between women divided into groups based on maternal country of origin. Logistic regression models were made with a forward selection strategy adjusting for potential mediators on the causal pathway from maternal country of origin to stillbirth.
A significantly higher risk of stillbirth was observed among women originating from Eastern Europe, the Middle East/Northern Africa, sub-Saharan Africa, and Asia, with the highest risk observed in women originating from sub-Saharan Africa (OR 2.40, 95% CI 2.16-2.67, p-value <0.001). After adjusting for maternal risk factors, fetuses small for gestational age, and socioeconomic factors, women originating from sub-Saharan Africa still had a significantly higher risk of stillbirth (OR 1.28, 95% CI 1.14-1.44, p-value <0.001) compared to women originating from Sweden. The risk among the other groups of foreign-born women was, however, equal to the risk among women originating from Sweden. Mediation analysis showed that 31.2% of the effect of sub-Saharan origin on stillbirth was mediated through fetuses small for gestational age, 12.7% through educational level, and 16.9% through disposable income level.
In Sweden, women originating from sub-Saharan Africa face a significantly higher risk of stillbirth even after adjusting for known risk factors. The higher risk is partly mediated by giving birth to fetuses small for gestational age and socioeconomic factors, but it cannot be explained altogether. This disparity may stem from multifactorial causes, including how risk populations utilize health care during pregnancies. Further studies are needed to find preventive measures to decrease the disparity.
在瑞典，来自撒哈拉以南非洲和中东地区的女性死产发生率较高。在这个超过200万例分娩的全国性队列研究中，我们评估了外国出生女性的死产风险因素，旨在了解哪些中介因素对死产风险升高影响最大。
这是一项在瑞典开展的全国性队列研究，纳入了2000年至2021年间的2300391例分娩。利用母亲的个人身份号码，将国家医疗出生登记处的数据与瑞典统计局的数据相链接。根据母亲的原籍国将女性分为不同组，分析各组母亲特征的差异。采用向前选择策略构建逻辑回归模型，对从母亲原籍国到死产的因果路径上的潜在中介因素进行调整。
来自东欧、中东/北非、撒哈拉以南非洲和亚洲的女性死产风险显著更高，其中撒哈拉以南非洲女性的风险最高（比值比2.40，95%置信区间2.16 - 2.67，p值<0.001）。在调整了母亲风险因素、小于胎龄儿和社会经济因素后，与瑞典女性相比，撒哈拉以南非洲女性的死产风险仍然显著更高（比值比1.28，95%置信区间1.14 - 1.44，p值<0.001）。然而，其他外国出生女性组的风险与瑞典女性的风险相当。中介分析表明，撒哈拉以南非洲血统对死产的影响中，31.2%通过小于胎龄儿介导，12.7%通过教育水平介导，16.9%通过可支配收入水平介导。
在瑞典，即使在调整了已知风险因素后，来自撒哈拉以南非洲的女性死产风险仍显著更高。较高的风险部分由分娩小于胎龄儿和社会经济因素介导，但无法完全解释。这种差异可能源于多因素原因，包括风险人群在孕期如何利用医疗保健。需要进一步研究以找到降低这种差异的预防措施。
