Risk factors for stillbirth at term: an Italian area-based, prospective cohort study.
access to antenatal cares
fertility treatments
prevention
risk factors
small for gestational age
stillbirth
term pregnancy
Journal
AJOG global reports
ISSN: 2666-5778
Titre abrégé: AJOG Glob Rep
Pays: United States
ID NLM: 101777907
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
medline:
23
10
2023
pubmed:
23
10
2023
entrez:
23
10
2023
Statut:
epublish
Résumé
Stillbirth at term has great emotional impact on both parents and professionals. In developed countries, efforts to identify risk factors are mandatory to plan area-specific prevention strategies. The aim of the study was to identify independent risk factors that contribute to stillbirth at 37 weeks' gestation or later. This was an area-based, prospective cohort study on pregnancy at term with enrolled from 2014 to 2021 in Emilia-Romagna, a north Italian region. Data were retrieved from both birth certificates and the Stillbirth Surveillance system database. To identify independent risk factors, a multivariate analysis using logistic regression was performed. A descriptive analysis of the causes of stillbirth is also reported. In the observation period, 246,437 babies born at term (including 260 stillbirths, giving a rate of 1.06/1000) were considered. The risk factors independently associated with stillbirth were small for gestational age babies (odds ratio, 2.58; 95% confidence interval, 1.88-3.53), pregnancy achieved though fertility treatments (odds ratio, 2.01; 95% confidence interval, 1.15-3.51), and delayed access to pregnancy services (odds ratio, 1.56; 95% confidence interval, 1.10-2.22). In multipara, the presence of a previous stillbirth (odds ratio, 3.91; 95% confidence interval, 1.98-7.72) was also associated with an increased risk for recurrence. Early- rather than late-term was an additional risk factor. The most frequent causes of death were placental and cord disorders (61/260 and 56/260, respectively). However, 28.1% of cases remain unexplained. The risks for stillbirth at term are known early in pregnancy or could be identified through tailored antenatal management, allowing effective preventive strategies to reduce preventable cases.
Sections du résumé
BACKGROUND
BACKGROUND
Stillbirth at term has great emotional impact on both parents and professionals. In developed countries, efforts to identify risk factors are mandatory to plan area-specific prevention strategies.
OBJECTIVE
OBJECTIVE
The aim of the study was to identify independent risk factors that contribute to stillbirth at 37 weeks' gestation or later.
STUDY DESIGN
METHODS
This was an area-based, prospective cohort study on pregnancy at term with enrolled from 2014 to 2021 in Emilia-Romagna, a north Italian region. Data were retrieved from both birth certificates and the Stillbirth Surveillance system database. To identify independent risk factors, a multivariate analysis using logistic regression was performed. A descriptive analysis of the causes of stillbirth is also reported.
RESULTS
RESULTS
In the observation period, 246,437 babies born at term (including 260 stillbirths, giving a rate of 1.06/1000) were considered. The risk factors independently associated with stillbirth were small for gestational age babies (odds ratio, 2.58; 95% confidence interval, 1.88-3.53), pregnancy achieved though fertility treatments (odds ratio, 2.01; 95% confidence interval, 1.15-3.51), and delayed access to pregnancy services (odds ratio, 1.56; 95% confidence interval, 1.10-2.22). In multipara, the presence of a previous stillbirth (odds ratio, 3.91; 95% confidence interval, 1.98-7.72) was also associated with an increased risk for recurrence. Early- rather than late-term was an additional risk factor. The most frequent causes of death were placental and cord disorders (61/260 and 56/260, respectively). However, 28.1% of cases remain unexplained.
CONCLUSION
CONCLUSIONS
The risks for stillbirth at term are known early in pregnancy or could be identified through tailored antenatal management, allowing effective preventive strategies to reduce preventable cases.
Identifiants
pubmed: 37868824
doi: 10.1016/j.xagr.2023.100269
pii: S2666-5778(23)00110-7
pmc: PMC10585316
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100269Informations de copyright
© 2023 The Authors.
Références
PLoS Med. 2019 Jul 2;16(7):e1002838
pubmed: 31265456
Am J Epidemiol. 1993 Jun 1;137(11):1177-89
pubmed: 8322759
Fertil Steril. 2020 Sep;114(3):579-586
pubmed: 32709377
PLoS One. 2023 Feb 22;18(2):e0277262
pubmed: 36812250
Hum Reprod. 2018 Feb 1;33(2):320-327
pubmed: 29140454
Lancet. 2011 May 14;377(9778):1703-17
pubmed: 21496907
J Pediatr Gastroenterol Nutr. 2010 Sep;51(3):353-61
pubmed: 20601901
BJOG. 2021 Oct;128(11):1775-1781
pubmed: 33837600
Arch Pathol Lab Med. 2016 Jul;140(7):698-713
pubmed: 27223167
BMJ. 2016 Sep 06;354:i4353
pubmed: 27599496
Fertil Steril. 2012 Oct;98(4):922-8
pubmed: 22763098
Am J Obstet Gynecol. 2018 Feb;218(2S):S790-S802.e1
pubmed: 29422212
Obstet Gynecol. 2002 Mar;99(3):483-9
pubmed: 11864678
Am J Obstet Gynecol. 2018 May;218(5):525.e1-525.e9
pubmed: 29462628
Lancet. 2011 Apr 16;377(9774):1331-40
pubmed: 21496916
N Engl J Med. 2004 Feb 19;350(8):777-85
pubmed: 14973215
Lancet. 2021 Aug 28;398(10302):772-785
pubmed: 34454675
BJOG. 2019 Jan;126(2):253-260
pubmed: 30341984
BMC Pregnancy Childbirth. 2019 Feb 20;19(1):77
pubmed: 30786865
Eur J Obstet Gynecol Reprod Biol. 1996 Aug;67(2):103-7
pubmed: 8841796
JAMA. 2014 Apr 16;311(15):1536-46
pubmed: 24737366
J Perinatol. 2010 May;30(5):311-8
pubmed: 19829298
Lancet. 2018 Nov 3;392(10158):1629-1638
pubmed: 30269876
Am J Clin Pathol. 2020 Jul 7;154(2):225-235
pubmed: 32338725
BMC Pregnancy Childbirth. 2019 Aug 5;19(1):276
pubmed: 31382995
BMJ. 2005 Nov 12;331(7525):1113-7
pubmed: 16236774
BJOG. 2014 Sep;121(10):1284-90; discussion 1291
pubmed: 24888505
J Perinat Med. 2022 May 27;50(6):748-752
pubmed: 35618670
Obstet Gynecol. 2020 Feb;135(2):453-462
pubmed: 31923063
BMJ. 2015 Jun 24;350:h3080
pubmed: 26109551
Am J Obstet Gynecol. 2001 Feb;184(3):489-96
pubmed: 11228508
Int J Environ Res Public Health. 2022 Feb 12;19(4):
pubmed: 35206265
BJOG. 2023 Aug;130(9):1060-1070
pubmed: 36852504
Am J Public Health. 1997 Aug;87(8):1323-7
pubmed: 9279268
Arch Gynecol Obstet. 2019 Mar;299(3):681-688
pubmed: 30578438
Am J Obstet Gynecol. 2013 May;208(5):376.e1-7
pubmed: 23523099
Hum Reprod. 2014 May;29(5):1090-6
pubmed: 24578477
Aust N Z J Obstet Gynaecol. 2012 Jun;52(3):242-7
pubmed: 22276935
Taiwan J Obstet Gynecol. 2014 Jun;53(2):141-5
pubmed: 25017256
Lancet Diabetes Endocrinol. 2016 Dec;4(12):1025-1036
pubmed: 27743975
J Matern Fetal Neonatal Med. 2022 Jul;35(14):2684-2689
pubmed: 32715816