Prepregnancy Risk Factors for Antepartum Stillbirth in the United States

Overview

Journal Obstet Gynecol

Specialty Gynecology & Obstetrics

Date 2010 Oct 23

PMID 20966697

Citations 62

Authors

Uma M Reddy

S Katherine Laughon

Liping Sun

James Troendle

Marian Willinger

Jun Zhang

Affiliations

Soon will be listed here.

Abstract

Objective: To identify possible prepregnancy risk factors for antepartum stillbirth and to determine whether these factors identify women at higher risk for term stillbirth.

Methods: This retrospective cohort study of prepregnancy risk factors compared 712 singleton antepartum stillbirths with 174,097 singleton live births at or after 23 weeks of gestation. The risk of term antepartum stillbirth then was assessed in a subset of 155,629 singleton pregnancies.

Results: In adjusted multivariable analyses, African-American race, Hispanic ethnicity, maternal age 35 years or older, nulliparity, prepregnancy body mass index (BMI) 30 or higher, preexisting diabetes, chronic hypertension, smoking, and alcohol use were independently associated with stillbirth. Prior cesarean delivery and history of preterm birth were associated with increased stillbirth risk in multiparous women. The risk of a term stillbirth for women who were white, 25-29 years old, normal weight, multiparous, no chronic hypertension, and no preexisting diabetes was 0.8 per 1,000. Term stillbirth risk increased with the following conditions: preexisting diabetes (3.1 per 1,000), chronic hypertension (1.7 per 1,000), African-American race (1.8 per 1,000), maternal age 35 years or older (1.3 per 1,000), BMI 30 or higher (1 per 1,000), and nulliparity (0.9 per 1,000).

Conclusion: There are multiple independent risk factors for antepartum stillbirth. However, the value of individual risk factors of race, parity, advanced maternal age (35-39 years old), and BMI to predict term stillbirth is poor. Our results do not support routine antenatal surveillance for any of these risk factors when present in isolation.

Level Of Evidence: II.

Citing Articles

Mental Illness in the 2 Years Prior to Pregnancy in a Population With Traumatic Brain Injury: A Cross-Sectional Study: La maladie mentale dans les deux ans précédant une grossesse dans une population souffrant de lésion cérébrale traumatique : une....

Brown H, Strauss R, Fung K, Mataruga A, Chan V, Mollayeva T Can J Psychiatry. 2024; 69(8):607-617.

PMID: 38659409 PMC: 11298096. DOI: 10.1177/07067437241249957.

Sleep disturbances in late pregnancy: associations with induction of labor.

Lahde H, Karlsson H, Karlsson L, Perasto L, Varis V, Rinne K Arch Gynecol Obstet. 2024; 310(4):2045-2053.

PMID: 38580856 PMC: 11393193. DOI: 10.1007/s00404-024-07492-4.

Antiretroviral Therapy Use Was Not Associated with Stillbirth or Preterm Birth in an Analysis of U.S. Medicaid Pregnancies to Persons with HIV.

Thompson K, Meyers D, Lee Y, Cu-Uvin S, Bengtson A, Wilson I Womens Health Rep (New Rochelle). 2023; 4(1):438-447.

PMID: 37638332 PMC: 10457643. DOI: 10.1089/whr.2023.0040.

Characteristics and outcomes of patients undergoing second-trimester dilation and evacuation for intrauterine fetal demise vs induced abortion.

Potter L, Ly S, Pei X, Ponzini M, Wilson M, Hou M Contraception. 2023; 126:110118.

PMID: 37453657 PMC: 10528417. DOI: 10.1016/j.contraception.2023.110118.

Racial and Ethnic Disparities in Stillbirth among Pregnant Women with Obesity.

Dongarwar D, Ajewole V, Spooner K, Tran V, Adebusuyi T, Onyenaka C Am J Perinatol. 2023; 41(S 01):e2138-e2144.

PMID: 37230474 PMC: 11059530. DOI: 10.1055/a-2099-8494.

References

Bahtiyar M, Julien S, Robinson J, Lumey L, Zybert P, Copel J . Prior cesarean delivery is not associated with an increased risk of stillbirth in a subsequent pregnancy: analysis of U.S. perinatal mortality data, 1995-1997. Am J Obstet Gynecol. 2006; 195(5):1373-8. DOI: 10.1016/j.ajog.2006.02.051. View

Smith G, Pell J, Dobbie R . Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. 2003; 362(9398):1779-84. DOI: 10.1016/s0140-6736(03)14896-9. View

Nohr E, Bech B, Davies M, Frydenberg M, Henriksen T, Olsen J . Prepregnancy obesity and fetal death: a study within the Danish National Birth Cohort. Obstet Gynecol. 2005; 106(2):250-9. DOI: 10.1097/01.AOG.0000172422.81496.57. View

Raymond E, Cnattingius S, Kiely J . Effects of maternal age, parity, and smoking on the risk of stillbirth. Br J Obstet Gynaecol. 1994; 101(4):301-6. DOI: 10.1111/j.1471-0528.1994.tb13614.x. View

Hogberg L, Cnattingius S . The influence of maternal smoking habits on the risk of subsequent stillbirth: is there a causal relation?. BJOG. 2007; 114(6):699-704. PMC: 1974832. DOI: 10.1111/j.1471-0528.2007.01340.x. View

Fretts R, Duru U . New indications for antepartum testing: making the case for antepartum surveillance or timed delivery for women of advanced maternal age. Semin Perinatol. 2008; 32(4):312-7. DOI: 10.1053/j.semperi.2008.04.016. View

Gardosi J, Kady S, McGeown P, Francis A, Tonks A . Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ. 2005; 331(7525):1113-7. PMC: 1283273. DOI: 10.1136/bmj.38629.587639.7C. View

Lydon-Rochelle M, Holt V, Nelson J, Cardenas V, Gardella C, Easterling T . Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records. Paediatr Perinat Epidemiol. 2005; 19(6):460-71. DOI: 10.1111/j.1365-3016.2005.00682.x. View

Reddy U, Ko C, Willinger M . Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol. 2006; 195(3):764-70. DOI: 10.1016/j.ajog.2006.06.019. View

10.

Sharma P, Salihu H, Oyelese Y, Ananth C, Kirby R . Is race a determinant of stillbirth recurrence?. Obstet Gynecol. 2006; 107(2 Pt 1):391-7. DOI: 10.1097/01.AOG.0000196501.32272.44. View

11.

MacDorman M, Kirmeyer S . Fetal and perinatal mortality, United States, 2005. Natl Vital Stat Rep. 2009; 57(8):1-19. View

12.

Salihu H, Sharma P, Kristensen S, Blot C, Alio A, Ananth C . Risk of stillbirth following a cesarean delivery: black-white disparity. Obstet Gynecol. 2006; 107(2 Pt 1):383-90. DOI: 10.1097/01.AOG.0000195103.46999.32. View

13.

Wisborg K, Ingerslev H, Henriksen T . IVF and stillbirth: a prospective follow-up study. Hum Reprod. 2010; 25(5):1312-6. DOI: 10.1093/humrep/deq023. View

14.

Zhang J, Troendle J, Reddy U, Laughon S, Branch D, Burkman R . Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010; 203(4):326.e1-326.e10. PMC: 2947574. DOI: 10.1016/j.ajog.2010.06.058. View

15.

Fretts R, Elkin E, Myers E, Heffner L . Should older women have antepartum testing to prevent unexplained stillbirth?. Obstet Gynecol. 2004; 104(1):56-64. DOI: 10.1097/01.AOG.0000129237.93777.1a. View

16.

Surkan P, Stephansson O, Dickman P, Cnattingius S . Previous preterm and small-for-gestational-age births and the subsequent risk of stillbirth. N Engl J Med. 2004; 350(8):777-85. DOI: 10.1056/NEJMoa031587. View

17.

MacDorman M, Kirmeyer S . The challenge of fetal mortality. NCHS Data Brief. 2009; (16):1-8. View

18.

Simpson L . Maternal medical disease: risk of antepartum fetal death. Semin Perinatol. 2002; 26(1):42-50. DOI: 10.1053/sper.2002.29838. View

19.

Huang D, Usher R, Kramer M, Yang H, Morin L, Fretts R . Determinants of unexplained antepartum fetal deaths. Obstet Gynecol. 2000; 95(2):215-21. DOI: 10.1016/s0029-7844(99)00536-0. View