Ethnic Disparities in Perinatal Mortality and Associated Factors: A Nationwide Cohort Study.

Abstract

To examine factors associated with perinatal mortality (PM) in women in minority ethnic groups (MEG) in Ireland and assess differences between them and their white counterparts. Retrospective population-based cohort study. Nineteen maternity units in the Republic of Ireland, 2011-2021. 4314 perinatal mortalities (3711 in white women; 603 in women in MEG) were reported to the National Perinatal Epidemiology Centre (NPEC). Chi-square testing was used to assess differences between groups. PM outcomes and socio-demographic, obstetric, and medical characteristics for mothers and infants were collected. Women in MEG who experienced PM were younger (p < 0.001) and 46% were employed (vs. 75% of white women, p < 0.001). More women in MEG had previous pregnancies (77% vs. 68%, p < 0.001), and more than double had ≥ 3 previous completed pregnancies versus white women (26% vs. 12%, p < 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs. 38%, p = 0.001). Twice as many women in MEG had booking appointments after 20 weeks' gestation or never received prenatal care (p < 0.001). Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies than white women (p = 0.047). The overrepresentation of women in MEG in PM data may be explained by factors such as employment status, parity, body mass index (BMI), and prenatal care access. Actionable measures are needed to address these issues, which could include initiatives to increase maternal health literacy, optimise maternal health preconception, and ensure prenatal care is accessible and culturally competent.