BACKGROUND: Data on the health status of the Roma people in Central and Eastern Europe are sparse and the reasons for their poor health are not clear. The objective of this study was to quantify the differences in birth outcomes between Roma and non-Roma mothers in the Czech Republic and to investigate the potential causes of such differences. METHOD: A population-based study recruited 8938 non-Roma and 1388 Roma hospitalised singleton births that occurred in two Czech districts (Teplice and Prachatice) between 1995 and 2004. During their stay in hospital, mothers completed a questionnaire on their demographic and socioeconomic characteristics and maternal smoking and alcohol consumption. Data on maternal height and weight and on infants' birth weight and gestational age were taken from hospital records. RESULTS: Birth weight and gestational age of Roma infants was 373 (SE 15) g and 0.92 (0.05) weeks, respectively, lower than in non-Roma infants. Controlling for demographic, socioeconomic and behavioural factors reduced these differences to 133 (18) g and 0.57 (0.06) weeks, respectively (all p-values < 0.001). In terms of binary outcomes, the Roma vs. non-Roma odds ratios were 4.5 (95% CI 3.7-5.4) for low birth weight (< 2500 g), 2.8 (2.2-3.4) for preterm birth (< 37 weeks of gestation), and 2.9 (2.5-3.4) for intrauterine grown retardation (<10th percentile of birth weight for gestational age); controlling for all covariates reduced these odds ratios to 1.7 (1.3-2.2), 1.5 (1.1-2.0) and 1.3 (1.0-1.6), respectively. Maternal education made the largest contribution to the ethnic differences; the role of health behaviours was relatively modest. CONCLUSION: There are striking differences in birth outcomes between Roma and non-Roma mothers. The causes of these differences are complex but largely socioeconomic.

International Centre for Health and Society Department of Epidemiology and Public Health University College London 1 19 Torrington Place London WC1E 6BT UK

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