Stillbirth risk by maternal socio-economic status and country of origin: A population-based observational study in Spai 2007-08

Background: Socio-economic differences are a major determinant of perinatal outcomes. The impact of low socio-economic status on the risk of stillbirt and the association between socio-economic status and stillbirth by maternal country of origin at a national level in Spain are unknown. We aimed to analyse the effect of maternal socio-economic status on the risk of stillbirth by maternal country of origin in Spain for the years 2007 and 2008. Methods: We designed a population-based observational study that included 970740 live births and 2464 stillbirths from 2007 to 2008. Univariate risk ratios (RRs) of stillbirth were calculated by maternal educatio country of origi ag parit and gestational age. Adjusted stillbirth RRs were calculated using a generalized linear model with the Poisson family. The adjusted attributable risks and aetiological fractions in the population were calculated as measures of impact. Results: Stillbirth rate ranged from 1.0 to 4.7 deaths per 1000 births. The stillbirth risk among mothers having secondary or lower education was double than that of mothers with a tertiary education with an adjusted RR of 2.13 [95 confidence interval (CI): 1.74-2.60]. African mother compared with mothers from Spai showed an adjusted stillbirth RR of 1.75 (95 CI: 1.54-2.00). Discussion: This study confirms the differences of stillbirth risk by maternal socio-economic status. Regardless of socio-economic statu African mothers had the highest risk of stillbirth. These results point out the necessity to reduce factors related to social and health inequalities in perinatal mortality in Spai and more specificall to take into consideration the special vulnerability of African mothers. © The Author 2012. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.