METHODOLOGY

The report is developed by using official birth and death data in Brussels Region, both medical and administrative data. Medical and socio-demographic data were linked and the analysis of evolutions of selected indicators of perinatal health has been performed.

RESULTS

A stabilization in the number of births has been observed since 2010 with a maximum number for 2010 (25,095 births). Since 2009, we have been observing an important increase in diabetes rate and in the proportion of overweight amongst pregnant women. A slow increase in the rate of cesarean section has been observed from 2008 (18.9%) to 2013 (20.7%), mainly concerning elective cesarean. The induction rate has been stable since 2011, while being close to the rate in Wallonia (31.5%) – the highest of Europe. Analysis of obstetric practices (induction, epidural, caesarean, episiotomy) shows wide disparities between maternities. Mothers with hypertension or diabetes and underweight mothers have higher risk of prematurity and low birth weight.

DISCUSSION - CONCLUSION

The increase of diabetes is likely to be multifactorial and may be related to the new diabetes screening policy during pregnancy but also to a real increase in the prevalence linked in particular to the obesity epidemic in the general population and to the increase in the pregnancy age. Diabetes screening and care for diabetic mothers and their children are essential to limit complications. The increase in the elective cesarean rate and a high induction rate seem to characterize the current trend towards «programmed obstetrics». It is important to note that induction of labor and caesarean section are not without risk and that their indications must be defined on a case by case basis to avoid iatrogenic effects. Avoiding the first cesarean section at all costs and attempting vaginal delivery after a previous caesarean section are two avenues that should be considered in order to lower the rate of cesarean section.