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Objective. To examine the association between region of origin and severe illness bringing a mother close to death (near-miss). Design. Retrospective cohort study. Setting. Maternity units in Lower Saxony, Germany. Population. 441 199 mothers of singleton newborns in 2001-2007. Methods. Using chi-squared tests, bivariate and multivariable logistic regression we examined the association between maternal region of origin and near-miss outcomes with prospectively collected perinatal data up to seven days postpartum. Main outcome measures. Hysterectomy, hemorrhage, eclampsia and sepsis rates. Results. Eclampsia was not associated with region of origin. Compared to women from Germany, women from the Middle East (OR 2.24; 95%CI 1.60-3.12) and Africa/Latin America/other countries (OR 2.17; 95%CI 1.15-4.07) had higher risks of sepsis. Women from Asia (OR 3.37; 95%CI 1.66-6.83) and from Africa/Latin America/other countries had higher risks of hysterectomy (OR 2.65; 95%CI 1.36-5.17). Compared to German women, the risk of hemorrhage was higher among women from Asia (OR 1.55; 95%CI 1.19-2.01) and lower among women from the Middle East (OR 0.66, 95%CI 0.55-0.78). Adjusting for maternal age, parity, occupation, partner status, smoking, obesity, prenatal care, chronic conditions and infertility showed no association between country of origin and risk of sepsis. Conclusion. Region of origin was a strong predictor for near-miss among women from the Middle East, Asia and Africa/Latin America/other countries. Confounders mostly did not explain the higher risks for maternal near-miss in these groups of origin. Clinical studies and audits are required to examine the underlying causes for these risks. [ABSTRACT FROM AUTHOR]