Differences in maternal and perinatal outcomes between Dutch and non-Western women in a midwife-led care setting: a retrospective cohort study
Authors: Ali F. , Horvat – Gitsels L. A , Bakker P. C. A. M , Verhoeven C. J. M. , van der Wal J. T. Gitsels- 
Published: November 2024

Abstract
Background
Previous research has shown that genetics and maternal medical, sociodemographic, lifestyle and psychosocial factors affect maternal and perinatal outcomes. Substantial research has been done on ethnic differences and maternal and perinatal outcomes in hospital settings. To our knowledge there are no studies about the associations between ethnicity and maternal and perinatal outcomes in a midwife-led care setting among low-risk women. Therefore, our study aimed to investigate possible ethnic associations between non-Western and Dutch women, and maternal and perinatal outcomes in a midwife-led care setting.

Methods
A retrospective cohort study was performed of low-risk pregnant women (n = 977) in midwife-led care. Data was collected from a medium-sized midwifery practice in an urban region near Amsterdam, the Netherlands. Regression analyses were performed to examine the effect of ethnicity on maternal and perinatal outcomes. Outcomes of interest were gestational age, mode of birth, perineal status, postpartum hemorrhage, birthweight, perinatal death and low Apgar score. Associations were corrected for deprived areas, body mass index (BMI), parity and maternal educational level. Potential effect modification for prenatal referral to obstetrician and parity were assessed.

Results
The study included 977 women, of whom 483 were non-Western, and 494 were Dutch. Regarding characteristics, compared to Dutch women, non-Western women were more likely to be multiparous (respectively 58.6% versus 49.2%; p = 0.003), live in a deprived area (34.0% versus 8.1%; p < 0.001), have limited formal education (medium: 46.0% versus 49.2%; low: 15.6% versus 7.4%; p < 0.001), have a higher BMI (overweight: 28.6% versus 22.9%; obese: 14.9% versus 12.0%; p = 0.045), make inadequate/intermediate use of prenatal care (7.2% versus 2.4%, p < 0.001) and suffer from gestational diabetes (17.2% versus 9.9%, p < 0.001). Whereas Dutch women were more likely to suffer from psychosocial problems during and/or before pregnancy (34.8% versus 23.0%, p < 0.001) and drink alcohol during pregnancy (5.9% versus 1.9%, p = 0.001). Regarding maternal and perinatal outcomes, non-Western women had increased odds of perineal laceration (OR 1.59, 95%CI 1.14–2.21) and decreased odds of high birthweight (0.50, 95%CI 0.29–0.84). The mode of birth differed by ethnicity. The interaction of prenatal referral and ethnicity was significant for the mode of birth. Therefore, for mode of birth the groups were stratified by prenatal referral (yes/no). In the prenatally referred group (n = 474), non-Western ethnicity was significantly associated with decreased odds of cesarean Sect. (0.63, 0.40–0.98). No other associations were significantly associated with ethnicity.

Conclusions
Maternal and perinatal outcomes differed between low-risk non-Western and Dutch women in a midwife-led care setting. Among non-Western women, perineal laceration occurred more often, and fewer children with high birthweight were born. In the prenatally referred group, women of non-Western ethnicity had decreased odds of cesarean section. Gestational age and postpartum hemorrhage were not significantly associated with ethnicity.