Author(s): Stillbirth Collaborative Res
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Abstract CONTEXT: Stillbirths account for almost half of US deaths from 20 weeks' gestation to 1 year of life. Most large studies of risk factors for stillbirth use vital statistics with limited data. OBJECTIVE: To determine the relation between stillbirths and risk factors that could be ascertained at the start of pregnancy, particularly the contribution of these factors to racial disparities. DESIGN, SETTING, AND PARTICIPANTS: Multisite population-based case-control study conducted between March 2006 and September 2008. Fifty-nine US tertiary care and community hospitals, with access to at least 90\% of deliveries within 5 catchment areas defined by state and county lines, enrolled residents with deliveries of 1 or more stillborn fetuses and a representative sample of deliveries of only live-born infants, oversampled for those at less than 32 weeks' gestation and those of African descent. MAIN OUTCOME MEASURE: Stillbirth. RESULTS: Analysis included 614 case and 1816 control deliveries. In multivariate analyses, the following factors were independently associated with stillbirth: non-Hispanic black race/ethnicity (23.1\% stillbirths, 11.2\% live births) (vs non-Hispanic whites; adjusted odds ratio [AOR], 2.12 [95\% CI, 1.41-3.20]); previous stillbirth (6.7\% stillbirths, 1.4\% live births); nulliparity with (10.5\% stillbirths, 5.2\% live births) and without (34.0\% stillbirths, 29.7\% live births) previous losses at fewer than 20 weeks' gestation (vs multiparity without stillbirth or previous losses; AOR, 5.91 [95\% CI, 3.18-11.00]; AOR, 3.13 [95\% CI, 2.06-4.75]; and AOR, 1.98 [95\% CI, 1.51-2.60], respectively); diabetes (5.6\% stillbirths, 1.6\% live births) (vs no diabetes; AOR, 2.50 [95\% CI, 1.39-4.48]); maternal age 40 years or older (4.5\% stillbirths, 2.1\% live births) (vs age 20-34 years; AOR, 2.41 [95\% CI, 1.24-4.70]); maternal AB blood type (4.9\% stillbirths, 3.0\% live births) (vs type O; AOR, 1.96 [95\% CI, 1.16-3.30]); history of drug addiction (4.5\% stillbirths, 2.1\% live births) (vs never use; AOR, 2.08 [95\% CI, 1.12-3.88]); smoking during the 3 months prior to pregnancy (<10 cigarettes/d, 10.0\% stillbirths, 6.5\% live births) (vs none; AOR, 1.55 [95\% CI, 1.02-2.35]); obesity/overweight (15.5\% stillbirths, 12.4\% live births) (vs normal weight; AOR, 1.72 [95\% CI, 1.22-2.43]); not living with a partner (25.4\% stillbirths, 15.3\% live births) (vs married; AOR, 1.62 [95\% CI, 1.15-2.27]); and plurality (6.4\% stillbirths, 1.9\% live births) (vs singleton; AOR, 4.59 [95\% CI, 2.63-8.00]). The generalized R(2) was 0.19, explaining little of the variance. CONCLUSION: Multiple risk factors that would have been known at the time of pregnancy confirmation were associated with stillbirth but accounted for only a small amount of the variance in this outcome.
This article was published in JAMA
and referenced in Journal of Nursing & Care