Association between stillbirth and risk factors known at pregnancy confirmation

Radek Bukowski, Marshall Carpenter, Deborah Conway, Donald Coustan, Donald J. Dudley, Robert L. Goldenberg, Carol J. Rowland Hogue, Matthew A. Koch, Corette B. Parker, Halit Pinar, Uma M. Reddy, George R. Saade, Robert M. Silver, Barbara J. Stoll, Michael W. Varner, Marian Willinger

Research output: Contribution to journalArticle

132 Scopus citations

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 R2 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.

Original languageEnglish (US)
Pages (from-to)2469-2479
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume306
Issue number22
DOIs
StatePublished - Dec 14 2011

ASJC Scopus subject areas

  • Medicine(all)

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    Bukowski, R., Carpenter, M., Conway, D., Coustan, D., Dudley, D. J., Goldenberg, R. L., Rowland Hogue, C. J., Koch, M. A., Parker, C. B., Pinar, H., Reddy, U. M., Saade, G. R., Silver, R. M., Stoll, B. J., Varner, M. W., & Willinger, M. (2011). Association between stillbirth and risk factors known at pregnancy confirmation. JAMA - Journal of the American Medical Association, 306(22), 2469-2479. https://doi.org/10.1001/jama.2011.1798