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- Title
The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH-21<sup>st</sup> Project.
- Authors
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.; Bhutta, Z. A.
- Abstract
<bold>Objectives: </bold>To identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well-dated pregnancies and access to antenatal care.<bold>Design: </bold>Population-based, prospective, observational study.<bold>Setting: </bold>Eight international urban populations.<bold>Population: </bold>Pregnant women and their babies enrolled in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.<bold>Methods: </bold>Cox proportional hazard models were used to compare risks among antepartum stillborn and liveborn babies.<bold>Main Outcome Measures: </bold>Antepartum stillbirth was defined as any fetal death after 16 weeks' gestation before the onset of labour.<bold>Results: </bold>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 <3rd centile was associated with antepartum stillbirth [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%.<bold>Conclusions: </bold>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.<bold>Tweetable Abstract: </bold>International stillbirth study finds individual risks poor predictors of death but combinations promising.
- Subjects
STILLBIRTH; FETAL development; PRENATAL care; PREGNANT women; FETAL death; BODY weight; COMPARATIVE studies; FETAL growth retardation; GESTATIONAL age; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PERINATAL death; RESEARCH; SYNDROMES; EVALUATION research; CROSS-sectional method; PROPORTIONAL hazards models
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2018, Vol 125, Issue 9, p1145
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14463