European perinatal health report: Health and care of pregnant women and babies in Europe in 2010
- Public Health Expertise
Healthy mothers and children are building blocks for a strong future in Europe. While infant and maternal mortality continue to decline, the burden of mortality and morbidity in the perinatal period — pregnancy, childbirth, and the postpartum — remains a major concern. This is because of the high number of births per year (over 5 million in Europe), the youth of the population harmed by adverse perinatal events (babies and women of childbearing age), and the long-term consequences of disabling complications of pregnancy such as very preterm birth or severe hypoxia.
The principal factors behind perinatal mortality and morbidity include very preterm birth, fetal growth restriction, and congenital anomalies. Babies born preterm and with low birth weight are more likely to die and to have long-term neurological and developmental disorders than those born at term. The incidence of these complications has increased in many countries, reflecting limited achievements in preventing high risk situations, compared with the medical advances that have reduced mortality for these infants. Stillbirths have declined less rapidly than neonatal deaths and, in many cases, their causes remain unknown. Women continue to die during childbirth, and substandard care is associated with a significant proportion of these deaths. As they grow up, babies born with major congenital anomalies or very preterm and with low birth weight may have important medical, social, and educational needs. These burdens fall disproportionately on socially disadvantaged women and babies and contribute to lifelong health inequalities.
Research on the early origins of adult diseases underscores the vital importance of the perinatal period for future health. Pregnancy complications which cause short-term morbidity — such as preterm birth and fetal growth restriction — are also associated with the development of chronic illnesses such as hypertension and metabolic disease across the life course. Further, risk factors for poor perinatal outcome — smoking, obesity, and alcohol use during pregnancy — continue to exert an effect through the child’s increased susceptibility to asthma, obesity, and developmental delays.
Despite the risks faced by women and children during pregnancy and childbirth, pregnancy is not an illness. Achieving optimal perinatal health thus involves a balance between intervening to manage and prevent complications, while minimising interventions that have negative side effects on health and induce anxiety among pregnant women and their families. Unnecessary medical interventions also contribute to the costs of providing health care without achieving gains in health.
The EURO-PERISTAT project aims to provide health professionals, health planners, and users of the healthcare systems with comparable data about the health and care of pregnant women and their babies in Europe. It uses routinely collected data, thus adding value to the resources used to generate them and providing opportunities for sharing and use of information. While many countries collect routine data nationally about women and children, these data are not available in currently existing international databases. The FIRST EURO-PERISTAT report, published with 2004 data in 2008, found wide differences in indicators of perinatal health and care between the countries in Europe. Documenting this variation is important because it shows that gains are possible in most countries, provides information about alternative options for care provision, and raises important questions about the effectiveness of national healthcare policies and the use of evidence-based care. The data in this report can be used as a point of comparison for individual countries. For those
indicators for which reliable data exist, countries can benchmark performance in providing effective health services and promoting the health of mothers and their newborn babies. Another aim is to reveal the strengths and weaknesses of perinatal health information systems and to encourage countries to invest in the resources needed to improve the completeness and quality of the data necessary for evidence-based public policy.