Teenage pregnancy and ethnicity in The Netherlands: frequency and obstetric outcome.

OBJECTIVES: To study differences in frequency and obstetric outcome of teenage pregnancy (not ending in induced abortion) between the main ethnic groups in The Netherlands. DESIGN: A retrospective cohort study based on the 1990-93 birth cohort in the National Obstetric Registry. SUBJECTS: A total of 10,583 teenagers and 54,501 20-24-year-old women who had a singleton pregnancy and were primiparous. MAIN OBSTETRIC OUTCOME MEASURES: These were perinatal death occurring between the 16th week of pregnancy and 24 h after birth, preterm birth and operative delivery (vaginal extraction and Cesarean section). METHOD: Comparison of the frequency of teenage pregnancy between ethnic groups and by bivariate and multivariate analysis of the three outcome measures between the teenage groups, the teenage groups and ethnically related 20-24-year-old women, and the teenage groups and Dutch 22-24-year-old women. RESULTS: A total of 55.2% of pregnant teenagers had non-Dutch ethnicity compared to 13.8% of all pregnant women. Islamic-Mediterranean teenagers constituted the largest group, one in four of all primiparous Mediterranean women being younger than 20 years of age, followed by black teenagers. Except for Hindustani teenagers, perinatal death occurred in all non-Dutch teenage groups more frequently than in Dutch teenagers, but the differences were only significant for black teenagers (odds ratios of black compared to Dutch teenagers were 2.89 (95% confidence interval (CI) 1.89-4.4) and 1.53 (95% CI 1.19-1.98), respectively). Rates for preterm birth were higher in black and Asian than in Dutch teenagers, but the difference was only significant for black teenagers (odds ratio 1.53, 95% CI 1.19-1.98). Compared to ethnically related 20-24-year-old women, rates of perinatal death and preterm birth were significantly higher in Dutch, black and Asian teenagers and, for preterm birth only, in Mediterranean teenagers. Correction for preterm birth showed that only part of these differences in perinatal death could be explained by preterm birth. Vaginal extraction and Cesarean section occurred less frequently in teenagers than in ethnically related (and in Dutch) 20-24-year-old women. Mediterranean teenagers had the lowest Cesarean section rate and Blacks the lowest vaginal extraction rate. CONCLUSION: Teenage pregnancy in The Netherlands is much more common in minority ethnic groups than in the indigenous population, particularly among Islamic-Mediterraneans and Blacks. Obstetric outcomes vary considerably, these being best in Hindustani and poorest in black teenagers, and being worse in teenagers than in 20-24-year-old women. However, teenagers less often had assisted delivery.

[Teenage pregnancy distribution by ethnicity in the Netherlands, 1990-1993]. / Tienerzwangerschappen naar etniciteit in Nederland, 1990-1993.

OBJECTIVE: To determine and compare the obstetrical results of teenage pregnancies among the main ethnic groups in the Netherlands. DESIGN: Retrospective cohort study. METHODS: From the cohorts 1990-1993 of the Landelijke Verloskundige Registratie (LVR, National Obstetrical Registration) the data were analysed concerning primiparae aged 14-19 years with a single pregnancy. RESULTS: During the period 1990-1993, 14.9% of the women whose parturitions were recorded in the LVR were allochtonous, of the teenage pregnancies recorded 55.2% occurred in an allochtonous population group. The numbers (percentages) of teenage pregnancies (primiparae, singles) in the various ethnic groups were 4742 (2.2%) in the autochtonous group, 3974 (25.9%) in the (Muslim) mediterraneous, 340 (7.8%) in the non-Dutch European, 588 (14.9%) in the Afro-allochtonous, 316 (9.7%) in the Hindustani, 263 (5.5%) in the Asian (excluding Hindustani and Asian Turkish) and 360 (10.4%) in the remaining ethnic groups. Hindustani and orthodox Muslims regard teenage pregnancy positively. The perinatal mortality was higher among Afro-allochtonous than among autochtonous teenagers (odds ratio: 2.89 (95% confidence interval: 1.89-4.40)), and the same was true of premature and immature parturition. Both findings occurred significantly more often in the autochtonous, Afro-allochtonous and Asian population parts than among women of the same ethnic groups aged 20-24 years. In relation to autochtonous women aged 20-24, the odds ratios for perinatal mortality and premature and immature parturition among Afro-allochtonous women were 3.64 (2.50-5.30) and 2.02 (1.59-2.55), respectively; after correction for pre- and immature parturition the odds ratio for perinatal mortality decreased to 2.35 (1.51-3.66). Low birth weight was less frequent among the Mediterraneans and more frequent among the Afro-allochtonous and Hindustani than among the autochtonous. Induced vaginal deliveries were less frequent among allochtonous teenagers, the risk of caesarean section was lower among Mediterranean teenagers but higher among Afro-allochtonous, Hindustani and other ethnic teenagers than among autochtonous teenagers. All groups of teenagers had lower frequencies of induced delivery than women of the same ethnic groups aged 20-24 years. CONCLUSIONS: Teenage pregnancy in the Netherlands occurs much more often among allochtonous than among autochtonous women and is encountered most often among (Muslim) mediterranean and Afro-allochtonous groups. Obstetrical results vary greatly from one ethnic teenage group to another; they are poorest among the Afro-allochtonous, best among the Hindustani group. Among the mediterranean teenagers, they are similar to those among the autochtonous group.

Perinatal death in ethnic minorities in The Netherlands.

OBJECTIVES: To investigate differences in perinatal death rate and associated obstetric risk factors between ethnic groups in the Netherlands. DESIGN: Retrospective cohort study based on the 1990-1993 birth cohorts in the National Obstetric Registry. SUBJECTS: 569,743 births of which 85,527 were for women belonging to ethnic minorities. MAIN OUTCOME MEASURES: Perinatal death occurring between 16th week of pregnancy and 24 hours after birth. METHOD: Bivariate and multivariate analysis of perinatal death rate per ethnic group. A total of 42,282 women living in the three main cities of the Netherlands were classified on the basis of postal code districts into four socioeconomic (SES) classes for analysis of the relation between SES, perinatal death, and preterm birth. RESULTS: Black mothers had the highest perinatal death rate compared with indigenous Dutch (odds ratio 2.2, 95% CI 1.9, 2.4) followed by a group "others", consisting of women of mixed or unknown ethnicity (odds ratio 1.8, 95% CI 1.5, 2.0), Hindustani (odds ratio 1.4, 95% CI 1.2, 1.6), and Mediterraneans (odds ratio 1.3, 95% CI 1.2, 1.4). Asians (excluding West Indian Asians) and non-Dutch Europeans did not have higher rates than Dutch women. The increased rates of black and Hindustani women could be explained fully and that of the group "others" partially by higher rates of preterm birth. Controlling for age and parity lowered the odds ratio of the Mediterraneans slightly. The risk of ethnicity was independent of SES. CONCLUSION: Ethnic minorities in the Netherlands except immigrants from Asia and other European countries have higher rates of perinatal death than indigenous Dutch women. With a twofold increase, black women had the highest rate, which was related to an equally large increased rate of preterm birth.