TY - JOUR
T1 - The antepartum stillbirth syndrome
T2 - risk factors and pregnancy conditions identified from the INTERGROWTH-21 st Project
AU - the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21 )
AU - Hirst, J. E.
AU - Villar, J.
AU - Victora, C. G.
AU - Papageorghiou, A. T.
AU - Finkton, D.
AU - Barros, F. C.
AU - Gravett, M. G.
AU - Giuliani, F.
AU - Purwar, M.
AU - Frederick, I. O.
AU - Pang, R.
AU - Cheikh Ismail, L.
AU - Lambert, A.
AU - Stones, W.
AU - Jaffer, Y. A.
AU - Altman, D. G.
AU - Noble, J. A.
AU - Ohuma, E. O.
AU - Kennedy, S. H.
AU - Bhutta, Z. A.
N1 - Publisher Copyright:
© 2016 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists
PY - 2018/8
Y1 - 2018/8
N2 - 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 st Project. 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 <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%. 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.
AB - 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 st Project. 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 <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%. 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.
KW - Antepartum stillbirth
KW - INTERGROWTH-21
KW - birth weight
KW - fetal growth restriction
UR - http://www.scopus.com/inward/record.url?scp=85049870215&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.14463
DO - 10.1111/1471-0528.14463
M3 - Article
C2 - 28029221
AN - SCOPUS:85049870215
SN - 1470-0328
VL - 125
SP - 1145
EP - 1153
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 9
ER -
