The Department of Health Information and Research has released the ‘European Perinatal Health Report’ (EPHR). This document was developed as part of an EU project and presents a comprehensive overview of perinatal (the period immediately before and after birth) health in 25 Member States of the European Union and Norway. Malta has participated actively in the development of this report which is based on 2004 data.
The report describes the various surveillance systems and data sources related to perinatal health available in EU Member States. Relevant data for Malta has been provided by the Department of Health Information and Research through the National Obstetrics Information System (NOIS), the National Mortality Register and the Malta Congenital Anomalies Register. For further details about this report you can access the NOIS (National Obstetrics Information System) website at:
http://www.sahha.gov.mt/pages.aspx?page=92  .
Malta had the smallest annual number of births reported from all the participating countries. Small number of events, especially rare events, makes comparisons with other countries difficult. Another difficulty when making country comparisons is the fact that in Malta induced abortion for fetal anomalies is illegal and thus infants with potentially fatal conditions will reach delivery and pass away soon after birth. This has the effect of increasing fetal, neonatal (first month after birth) and infant (up to one year of age) mortality and morbidity rates, and also the induction and operative delivery rates.
Childbearing in both the lower and higher maternal age groups is associated with an increased risk of preterm birth, growth restriction and mortality in the perinatal period. Malta has a teenage delivery rate of 5.8% of all women delivering. It ranges from 1.3% in Denmark to 9.3% in Latvia. These variations reflect different cultures and practices. A total of 11.7% of women were registered as delivering at 35 years or older in Malta. This rate ranged from 7.5% in Slovakia to 24.3% in Ireland.
Smoking during pregnancy has been associated with fetal growth restriction, preterm birth and perinatal death. 7.2% of women in Malta reported smoking during pregnancy. This is a comparatively low rate and may be an underestimate as many women are reluctant to report smoking habits at their antenatal visits when this information is collected. The highest rate reported was 22% for Wales and the lowest was 4.8% for Lithuania.
Pregnancy and childbirth is a natural process and should require minimal medical intervention. Rates of induced labour and caesarean section in developed countries have increased in the last decade. Both procedures are associated with risks for the mother and fetus and provide an indicator of obstetric practice.
The rate of vaginal non-instrumental births in Malta was 67.8% of total births. This rate varied in the different countries ranging from 82.8% in Slovenia to 53.8% in Portugal. 3.8% of total births were instrumental vaginal deliveries including forceps, ventouse and breech extractions while the rest (28.3%) were births by caesarean section.
The highest caesarean section rate was reported from Italy at 37.8% of total births, followed by Portugal (33.1%), Ireland (29.5%) and Malta (28.3%). The lowest rate was reported from Slovenia at 14.4%.
85.4% of births in Malta occurred in a large maternity unit catering for over 3000 births per year while 14.5% of births occurred in small maternity units catering for less than 300 births per year. Breast feeding is considered of benefit to babies in terms of both nutrients and resistance to infection. The rate of newborns breastfed during the first 48 hours was reported as 68.4% for Malta. Four centres reported lower rates: Ireland (45.6%), France (62.3%), Northern Ireland (63.0%) and Wales (67.0%). The highest rate of breast feeding in the first 48 hours was reported from Sweden at 97.9%.
Maternal deaths are rare events in all EU countries. Malta did not register any maternal deaths in 2003 or 2004.
The neonatal mortality (number of deaths up to 28 completed days of birth) was 4.4/1000 live births for Malta (highest 5.7 for Latvia and lowest 1.6 for Cyprus). Most neonatal deaths are associated with preterm birth and congenital anomalies. As Malta does not allow induced abortion for fetal anomalies, it is understandable that neonatal mortality rates will be increased.
Infant mortality (number of deaths following live birth and until one year of age) for Malta was reported at 5.9/1000 live births (highest 9.4/1000 live births for Latvia and lowest 3.0/1000 live births for Sweden and Norway). Malta reports the highest rate of total neonatal mortality (until 28 days of life) due to congenital anomalies (2.3/1000 live births). This may be explained by the fact that induced abortion for fetal anomalies is illegal in Malta. The percentage of early neonatal deaths (until 7 days of life) due to congenital anomalies is also high at 41.7%. This is followed by Ireland at 40.1%.
The EPHR is a first attempt at bringing together standardized perinatal health indicators for Europe. It has proven that it is feasible to collect such indicators and will hopefully act as a catalyst for resourcing ongoing perinatal health indicator data collection and reporting across Europe.
The Department of Health Information and Research would like to acknowledge the important contribution of all data providers to the National Obstetrics Information System (NOIS) register, who provide data on a voluntary basis and without whose co-operation such work would not be possible. The National Mortality Register and Malta Congenital Anomalies Register have also provided important data towards the compilation of this European Perinatal Health Report.