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Objectives  This analysis explores the association between preterm birth and maternal country of birth in a French district with a multiethnic population.

Design  Prospective observational study.

Setting  District of Seine-Saint-Denis in France

Population  48,746 singleton live births from a population-based birth register between October 1998 and December 2000.

Methods  We compare preterm birth rates by mother's country of birth controlling for demograhic and obstetric factors as well as insurance coverage and timing of initiation of antenatal care.

Main outcome measures  Overall preterm birth rates and preterm birth rates by timing of delivery (<33 weeks versus 33–36 weeks of gestation), mode of onset (spontaneous or indicated preterm birth) and the presence of hypertension in pregnancy.

Results  Women born in Northern Africa, Southern Europe and South/East Asia did not have higher preterm birth rates than women born in continental France. Rates were significantly higher for women born in the overseas French districts in the Caribbean and Indian Ocean and Sub-Saharan Africa. Excess risk was greatest for early preterm births, medically indicated births and preterm births associated with hypertension.

Conclusions  Patterns of preterm birth with relation to timing, mode of onset and medical complications among of Afro-Caribbean origin should be confirmed in future research.