BJOG : an international journal of obstetrics and gynaecology
Cross-Sectional Studies; Female; Fetal Growth Retardation; Fetal Weight; Gestational Age; Humans; Infant, Newborn; Pregnancy; Proportional Hazards Models; Prospective Studies; Risk Factors; Stillbirth; Syndrome
OBJECTIVES: To identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well-dated pregnancies and access to antenatal care.
DESIGN: Population-based, prospective, observational study.
SETTING: Eight international urban populations.
POPULATION: Pregnant women and their babies enrolled in the Newborn Cross-Sectional Study of the INTERGROWTH-21
METHODS: Cox proportional hazard models were used to compare risks among antepartum stillborn and liveborn babies.
MAIN OUTCOME MEASURES: Antepartum stillbirth was defined as any fetal death after 16 weeks' gestation before the onset of labour.
RESULTS: Of 60 121 babies, 553 were stillborn (9.2 per 1000 births), of which 445 were antepartum deaths (7.4 per 1000 births). After adjustment for site, risk factors were low socio-economic status, hazard ratio (HR): 1.6 (95% CI, 1.2-2.1); single marital status, HR 2.0 (95% CI, 1.4-2.8); age ≥40 years, HR 2.2 (95% CI, 1.4-3.7); essential hypertension, HR 4.0 (95% CI, 2.7-5.9); HIV/AIDS, HR 4.3 (95% CI, 2.0-9.1); pre-eclampsia, HR 1.6 (95% CI, 1.1-3.8); multiple pregnancy, HR 3.3 (95% CI, 2.0-5.6); and antepartum haemorrhage, HR 3.3 (95% CI, 2.5-4.5). Birth weight[HR, 4.6 (95% CI, 3.4-6.2)]. The greatest risk was seen in babies not suspected to have been growth restricted antenatally, with an HR of 5.0 (95% CI, 3.6-7.0). The population-attributable risk of antepartum death associated with small-for-gestational-age neonates diagnosed at birth was 11%.
CONCLUSIONS: Antepartum stillbirth is a complex syndrome associated with several risk factors. Although small babies are at higher risk, current growth restriction detection strategies only modestly reduced the rate of stillbirth.
TWEETABLE ABSTRACT: International stillbirth study finds individual risks poor predictors of death but combinations promising.
Women & Children
Hirst, J E; Villar, J; Victora, C G; Papageorghiou, A T; Finkton, D; Barros, F C; Gravett, M G; Giuliani, F; Purwar, M; Frederick, I O; Pang, R; Cheikh Ismail, L; Lambert, A; Stones, W; Jaffer, Y A; Altman, D G; Noble, J A; Ohuma, E O; Kennedy, S H; and Bhutta, Z A, "The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH-21" (2018). Articles, Abstracts, and Reports. 1177.