CHARACTERISTICS OF CHILDBEARING WOMEN  

Some risk factors for poor perinatal outcome increased, while others decreased. Levels of risk vary greatly between countries.

  Multiple pregnancies: Multiple pregnancy rates differ widely throughout Europe, ranging from lows of 9 to 13 per 1000 women with live births or stillbirths in Romania, Latvia, Lithuania, and Poland to more than 20 per 1000 in Brussels, the Czech Republic, Denmark, Cyprus, Spain, and Malta. However, rates rose in 20 of the 23 countries that provided data on this indicator in both time periods. Babies from multiple births are 10 times more likely than singletons to be delivered preterm and as a result have higher risks of neonatal and infant death.

  Maternal age: Since 2004, the average age of women giving birth in Europe has risen, but the proportions of mothers 35 years and older vary between countries from 10.9% in Romania to 34.7% in Italy. Births to mothers aged under 20 are uncommon (2% or lower in many countries), but in some countries, they account for over 5% of births (United Kingdom, Hungary, Latvia, Malta, Slovakian, and Romania.

  Smoking during pregnancy: Our data show a decline over time in countries for which these data were available. In many countries, however, more than 10% of women continue to smoke during pregnancy. Countries with highest proportions of smokers were:  Spain (data from Catalonia – 14.4%), France (17.7%), and some UK countries, including Scotland (19%), Wales (16%), Northern Ireland (15%). Eleven countries had no data on this indicator.

  Underweight, overweight and obesity: Data on maternal prepregnancy body mass index were collected for the first time in this report although 18 countries did not have these data. In many countries, more than 10% of pregnant women were obese, with highs in Wallonia in Belgium (13.6%), Germany (13.7%), and Scotland (20.6%).

HEALTH SERVICES

Caesarean section rates increased in most countries between 2004 and 2010. With the exception of Finland and Sweden, where rates declined, increases were widespread ranging from under 0.2% in Italy to over 7% in Lithuania, Slovakia, and Poland. In general, increases were most marked in the countries of central and eastern Europe and in Germany and Austria.

Practices related to caesarean section have not converged over time. Rates in 2010 ranged from 52.2% in Cyprus, 38.0% in Italy, 36.9% in Romania and 36.3% in Portugal to below 20% in the Netherlands, Slovenia, Finland, Sweden, Iceland, and Norway. Differences in population risk factors for caesarean section, such as maternal age and parity do not suffice to explain these wide differences. Among countries with high proportions of older mothers Italy and Portugal had high caesarean section rates while the Netherlands and Finland had lower rates.

Variations in obstetric practices raise questions about the role of scientific evidence in clinical decision making. In addition to caesarean, other aspects of clinical practice also varied widely. For example, episiotomy rates ranged from 5% to 70% of vaginal deliveries, yet current evidence does not support routine use of this procedure. Rates were around 70% in Cyprus, Poland, Portugal, and Romania and ranged from 43-58% in Wallonia and Flanders in Belgium and in Spain. The lowest rates – between 5 and 7% – were reported in Denmark, Sweden, and Iceland.

Up to 5 to 6% of births in some countries may occur after use of some form of assisted reproductive techniques (ART), although the use of the less invasive procedures is under-reported in most data systems or not reported at all. Births after in vitro fertilisation (IVF) accounted for 2 to 4% of all births. Many countries are implementing policies to prevent multiple pregnancies in assisted conception, and the decrease in twin rates observed in some countries – such as Denmark, the Netherlands and Norway – may be the result of these policies. In contrast, the substantial increases in twin birth rates observed in Italy, Malta, Luxembourg, Brussels in Belgium and the Czech Republic could result from more widespread use of ART without clear practice guidelines.

While the proportion of births in larger maternity units has increased in many countries, the size of maternity units still varies widely. Overall, few births occurred in maternity units with fewer than 500 births in 2010, but this proportion was higher in some countries (16.1% in Germany, 17.6% in Estonia, 18.3% in Switzerland, and 61.9% in Cyprus). At the other end of the spectrum, in Denmark, Ireland, Latvia, Slovenia, Sweden, England and Scotland, over one quarter of births take place in maternity units with 5000 or more deliveries per year.

THE FUTURE OF PERINATAL HEALTH REPORTING IN EUROPE

European countries face common challenges related to the health and care of mothers and babies as shown by the results of this and the previous Euro-Peristat report. By making its perinatal health indicators widely available to health planners, clinicians, researchers and users, Euro-Peristat seeks to promote evidence-based actions to improve maternal and child health. Yet to build a truly sustainable system, further actions are needed to: