Objective: To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery.Design: Analysis of aggregate data from routine sources.Setting: Nineteen European countries.Population: Live births in 1996, 2000, 2004, and 2008.Methods: Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log‐binomial regression models.Main outcome measures: Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non‐spontaneous (induced or prelabour caesarean section) onset of labour.Results: Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35–36 weeks of gestation than at 32–34 weeks of gestation. Variable trends were observed for spontaneous and non‐spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non‐spontaneous preterm births.Conclusions: There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross‐country differences could inform strategies for the prevention of preterm birth.

The first European Perinatal Health Report showed wide variability between European countries in fetal (2.6–9.1‰) and neonatal (1.6–5.7‰) mortality rates in 2004. We investigated gestational age patterns of fetal and neonatal mortality to improve our understanding of the differences between countries with low and high mortality. Data on 29 countries/regions participating in the Euro-Peristat project were analyzed. Most European countries had no limits for the registration of live births, but substantial variations in limits for registration of stillbirths before 28 weeks of gestation existed. Country rankings changed markedly after excluding deaths most likely to be affected by registration differences (22–23 weeks for neonatal mortality and 22–27 weeks for fetal mortality). Countries with high fetal mortality ≥28 weeks had on average higher proportions of fetal deaths at and near term (≥37 weeks), while proportions of fetal deaths at earlier gestational ages (28–31 and 32–36 weeks) were higher in low fetal mortality countries. Countries with high neonatal mortality rates ≥24 weeks, all new member states of the European Union, had high gestational age-specific neonatal mortality rates for all gestational-age subgroups; they also had high fetal mortality, as well as high early and late neonatal mortality. In contrast, other countries with similar levels of neonatal mortality had varying levels of fetal mortality, and among these countries early and late neonatal mortality were negatively correlated. For valid European comparisons, all countries should register births and deaths from at least 22 weeks of gestation and should be able to distinguish late terminations of pregnancy from stillbirths. After excluding deaths most likely to be influenced by existing registration differences, important variations in both levels and patterns of fetal and neonatal mortality rates were found. These disparities raise questions for future research about the effectiveness of medical policies and care in European countries.

Please cite this paper as: Bouvier‐Colle M, Mohangoo A, Gissler M, Novak‐Antolic Z, Vutuc C, Szamotulska K, Zeitlin J for The Euro‐Peristat Scientific Committee. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe. BJOG 2012;119:880–890.Objective  To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity.Design  Analysis of aggregate data from routine statistical systems compiled by the EURO‐PERISTAT project and comparison with data from national enquiries.Setting  Twenty‐five countries in the European Union and Norway.Population  Women giving birth in participating countries in 2003 and 2004.Methods  Application of a common collection of data by selecting specific International Classification of Disease codes from the ‘Pregnancy, childbirth and the puerperium’ chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies.Main outcome measures  Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive‐care unit admission.Results  In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100 000 live births overall and ranged from 0 to 29.6. Under‐ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women).Conclusions  Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended.

Objective: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons.Design: Population‐based study.Setting: Twenty‐seven European countries, the United States, Canada and Japan in 2010.Population: A total of 9 376 252 singleton births.Method: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22–23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings.Main outcome measures: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source.Results: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22–23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22–23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged.Conclusions: International comparisons of very preterm birth rates using routine data should exclude births at 22–23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high‐income countries.Tweetable International comparisons of VPT rates should exclude births at 22–23 weeks of gestation and terminations of pregnancy.