Population Based Cohort Study of Fetal Deaths, and Neonatal and Perinatal Mortality at Term Within a Somali Diaspora

Abstract Background: Delivery among Somali women occurs later, we have no information on the associated perinatal mortality. Our objective is to compare perinatal mortality among Somali women with the population rates.Methods: This is a retrospective cohort study 2011-2017. Information was obtained from certificates of birth, neonatal and fetal death through data use agreement signed between the Minnesota Department of Health and the University of Minnesota. Data derived from 470,550 non-anomalous births >20 weeks of gestation in Minnesota 2011-2017. We included all U.S. born White, U.S. born Black, women born in Somalia or self-identified as Somali, and women who identified as Hispanic regardless of place of birth (377,426), and excluded births <37 weeks and >42 weeks, > 1 fetus, age <18 or >45 years, or women of other ethnicities. The exposure was documented ethnicity or place of birth, and the outcomes were live birth, fetal death, neonatal death prior to 28 days, and perinatal mortality rates. These were calculated using binomial proportions with 95% confidence intervals and compared using odds ratios (aOR) adjusted for diabetes, hypertension and maternal body mass index.Results: The aOR for fetal and neonatal death in the Somali cohort was greater than for U.S. born White (aOR, 2.05 [95%CI: 1.49 - 2.83], aOR 1.84 [95%CI: 1.36 - 2.48]) and Hispanic women (aOR, 1.90 [95%CI: 1.30 - 2.79] and 1.47 [95%CI: 1.05 - 2.06] respectively). Limiting the analysis to those with spontaneous onset of labor (SOL) did not modify the results. This effect persisted up to 41 weeks after which the risk was similar to that of U.S. born White women but lower than for U.S. born Black women and Hispanic women.Conclusions: Despite greater mean gestational age, Somali fetal death rates are similar to population rates. Neonatal mortality is increased compared with White women, but similar to that of other minorities in Minnesota. Somali neonatal mortality decreased and was comparable to that of the White population after 41 weeks.