RESUMEN
BACKGROUND: Stillbirth rates remain a global priority and in Australia, progress has been slow. Risk factors of stillbirth are unique in Australia due to large areas of remoteness, and limited resource availability affecting the ability to identify areas of need and prevalence of factors associated with stillbirth. This retrospective cohort study describes lifestyle and sociodemographic factors associated with stillbirth in South Australia (SA), between 1998 and 2016. METHODS: All restigered births in SA between 1998 ad 2016 are included. The primary outcome was stillbirth (birth with no signs of life ≥ 20 weeks gestation or ≥ 400 g if gestational age was not reported). Associations between stillbirth and lifestyle and sociodemographic factors were evaluated using multivariable logistic regression and described using adjusted odds ratios (aORs). RESULTS: A total of 363,959 births (including 1767 stillbirths) were included. Inadequate antenatal care access (assessed against the Australian Pregnancy Care Guidelines) was associated with the highest odds of stillbirth (aOR 3.93, 95% confidence interval (CI) 3.41-4.52). Other factors with important associations with stillbirth were plant/machine operation (aOR, 1.99; 95% CI, 1.16-2.45), birthing person age ≥ 40 years (aOR, 1.92; 95% CI, 1.50-2.45), partner reported as a pensioner (aOR, 1.83; 95% CI, 1.12-2.99), Asian country of birth (aOR, 1.58; 95% CI, 1.19-2.10) and Aboriginal/Torres Strait Islander status (aOR, 1.50; 95% CI, 1.20-1.88). The odds of stillbirth were increased in regional/remote areas in association with inadequate antenatal care (aOR, 4.64; 95% CI, 2.98-7.23), birthing age 35-40 years (aOR, 1.92; 95% CI, 1.02-3.64), Aboriginal and/or Torres Strait Islander status (aOR, 1.90; 95% CI, 1.12-3.21), paternal occupations: tradesperson (aOR, 1.69; 95% CI, 1.17-6.16) and unemployment (aOR, 4.06; 95% CI, 1.41-11.73). CONCLUSION: Factors identified as independently associated with stillbirth odds include factors that could be addressed through timely access to adequate antenatal care and are likely relevant throughout Australia. The identified factors should be the target of stillbirth prevention strategies/efforts. SThe stillbirth rate in Australia is a national concern. Reducing preventable stillbirths remains a global priority.
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Estilo de Vida , Mortinato , Humanos , Mortinato/epidemiología , Mortinato/etnología , Estudios Retrospectivos , Femenino , Australia del Sur/epidemiología , Factores de Riesgo , Embarazo , Adulto , Atención Prenatal/estadística & datos numéricos , Factores Sociodemográficos , Adulto Joven , Modelos Logísticos , Factores Socioeconómicos , Accesibilidad a los Servicios de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: First Nations Peoples endure disproportionate rates of stillbirth compared with non-First Nations Peoples. Previous interventions have aimed at reducing stillbirth in First Nations Peoples and providing better bereavement care without necessarily understanding the perceptions, knowledge and beliefs that could influence the design of the intervention and implementation. AIM: The aim of this review was to understand the perceptions, knowledge and beliefs about stillbirth prevention and bereavement of First Nations Peoples from the US, Canada, Aotearoa/New Zealand, and Australia. METHODS: This review was conducted in accordance with the JBI methodology for a convergent integrated mixed method systematic review. This review was overseen by an advisory board of Aboriginal Elders, researchers, and clinicians. A search of eight databases (PubMed, MEDLINE, PsycInfo, CINAHL, Embase, Emcare, Dissertations and Theses and Indigenous Health InfoNet) and grey literature was conducted. All studies were screened, extracted, and appraised for quality by two reviewers and results were categorised, and narratively summarised. RESULTS: Ten studies were included within this review. Their findings were summarised into four categories: safeguarding baby, traditional practices of birthing and grieving, bereavement photography and post-mortem examination. The results indicate a diversity of perceptions, knowledge and beliefs primarily around smoking cessation and bereavement practices after stillbirth. However, there was a paucity of research available. CONCLUSIONS: Further research is needed to understand the perceptions, knowledge and beliefs about stillbirth among First Nations Peoples. Without research within this area, interventions to prevent stillbirth and support bereaved parents and their communities after stillbirth may face barriers to implementation.
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Aflicción , Conocimientos, Actitudes y Práctica en Salud , Pueblos Indígenas , Mortinato , Femenino , Humanos , Embarazo , Australia , Canadá , Pueblos Indígenas/psicología , Nueva Zelanda , Mortinato/psicología , Mortinato/etnología , Estados UnidosRESUMEN
OBJECTIVE: To evaluate the relative importance of ethnicity and socioeconomic deprivation in determining the likelihood and prevalence of placentally derived composite of adverse pregnancy outcomes (CAPO) and composite of severe adverse pregnancy outcomes (CAPO-S). METHODS: This was a single-center retrospective cohort study of data obtained in a tertiary maternity unit. Data regarding ethnicity and socioeconomic deprivation (as measured with indices of multiple deprivation) were collected for 13 165 singleton pregnancies screened routinely in the first trimester for pre-eclampsia using the Fetal Medicine Foundation combined risk-assessment algorithm. CAPO was defined as the presence of one or more interrelated outcomes associated with placental dysfunction, namely, hypertensive disorders of pregnancy, preterm birth, birth weight ≤ 10th centile and stillbirth. CAPO-S was defined as the presence of one or more of the following: hypertensive disorders of pregnancy at < 37 + 0 weeks, preterm birth at < 34 + 0 weeks, birth weight ≤ 5th centile and stillbirth at < 37 + 0 weeks. RESULTS: The prevalence of CAPO was 16.3% in white women, 29.3% in black women and 29.3% in South Asian women. However, half (51.7%) of all CAPO cases occurred in white women. There was a strong interaction between ethnicity and socioeconomic deprivation, with a correlation coefficient of -0.223. Both ethnicity and socioeconomic deprivation influenced the prevalence of CAPO and CAPO-S, with the contribution of ethnicity being the strongest. CONCLUSIONS: Black and Asian ethnicity, as well as socioeconomic deprivation, influence the prevalence of placenta-mediated adverse pregnancy outcomes. Despite this, most adverse pregnancy outcomes occur in white women, who represent the majority of the population and are also affected by socioeconomic deprivation. For these reasons, inclusion of socioeconomic deprivation should be considered in early pregnancy risk assessment for placenta-mediated CAPO. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Origen étnico materno y privación socioeconómica: influencia en los resultados adversos del embarazo OBJETIVO: Evaluar la importancia relativa de la etnia y la privación socioeconómica en la determinación de la probabilidad y la prevalencia de los resultados adversos compuestos del embarazo relacionados con la placenta (CAPO, por sus siglas en inglés) y los resultados adversos compuestos graves del embarazo (CAPOS). MÉTODOS: Se trata de un estudio de cohortes retrospectivo unicéntrico de datos obtenidos en una unidad de maternidad terciaria. Se recopilaron datos relativos al origen étnico y la privación socioeconómica (mediante índices de privación múltiple) de 13 165 embarazos únicos sometidos a cribado rutinario en el primer trimestre para detectar la preeclampsia mediante el algoritmo combinado de evaluación de riesgos de la Fetal Medicine Foundation. Los CAPO se definieron como la presencia de uno o más resultados interrelacionados asociados con una disfunción placentaria, como trastornos hipertensivos del embarazo, parto prematuro, peso al nacer ≤10° percentil y éxitus fetal. Los CAPOS se definieron como la presencia de uno o más de los siguientes: trastornos hipertensivos del embarazo <37+0 semanas, parto prematuro a <37+0 semanas, peso al nacer ≤5° percentil y éxitus fetal a <37+0 semanas. RESULTADOS: La prevalencia de los CAPO fue del 16,3% en las mujeres blancas, del 29,3% en las negras y del 29,3% en las sudasiáticas. Sin embargo, la mitad (51,7%) de todos los casos de CAPO se produjeron en mujeres blancas. Hubo una fuerte interacción entre etnia y privación socioeconómica, con un coeficiente de correlación de −0,223. Tanto la etnia como la privación socioeconómica influyeron en la prevalencia de los CAPO y CAPOS, siendo la contribución de la etnia la más fuerte. CONCLUSIONES: Las etnias negra y asiática, así como la privación socioeconómica, influyen en la prevalencia de resultados adversos del embarazo relacionados con la placenta. A pesar de ello, la mayoría de los resultados adversos del embarazo se producen en mujeres blancas, que representan la mayoría de la población y también se ven afectadas por la privación socioeconómica. Por estas razones, debe considerarse la inclusión de la privación socioeconómica en la evaluación temprana del riesgo de CAPO relacionados con la placenta durante el embarazo.
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Etnicidad , Resultado del Embarazo , Factores Socioeconómicos , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Adulto , Resultado del Embarazo/etnología , Resultado del Embarazo/epidemiología , Etnicidad/estadística & datos numéricos , Nacimiento Prematuro/etnología , Nacimiento Prematuro/epidemiología , Prevalencia , Mortinato/epidemiología , Mortinato/etnología , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/etnología , Preeclampsia/epidemiología , Preeclampsia/etnología , Recién Nacido , Población Blanca/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricosRESUMEN
OBJECTIVE: The objective of this review is to investigate First Nations populations' perceptions, knowledge, attitudes, beliefs, and myths about stillbirth. INTRODUCTION: First Nations populations experience disproportionate rates of stillbirth compared with non-First Nations populations. There has been a surge of interventions aimed at reducing stillbirth and providing better bereavement care, but these are not necessarily appropriate for First Nations populations. As a first step toward developing appropriate interventions for these populations, this review will examine current perceptions, knowledge, attitudes, beliefs, and myths about stillbirth held by First Nations people from the United States, Canada, Aotearoa/New Zealand, and Australia. INCLUSION CRITERIA: The review will consider studies that include individuals of any age (bereaved or non-bereaved) who identify as belonging to First Nations populations. Eligible studies will include the perceptions, knowledge, attitudes, beliefs, and myths about stillbirth among First Nations populations. METHODS: This review will follow the JBI methodology for convergent mixed methods systematic reviews. The review is supported by an advisory panel of Aboriginal elders, lived-experience stillbirth researchers, Aboriginal researchers, and clinicians. PubMed, MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), Emcare (Ovid), PsycINFO (EBSCOhost), Indigenous Health InfoNet, Trove, Informit, and ProQuest Dissertations and Theses will be searched for relevant information. Titles and abstracts of potential studies will be screened and examined for eligibility. After critical appraisal, quantitative and qualitative data will be extracted from included studies, with the former "qualitized" and the data undergoing a convergent integrated approach. REVIEW REGISTRATION: PROSPERO CRD42023379627.
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Aflicción , Muerte Fetal , Conocimientos, Actitudes y Práctica en Salud , Pueblos Indígenas , Mortinato , Anciano , Femenino , Humanos , Embarazo , Canadá , Literatura de Revisión como Asunto , Mortinato/etnología , Mortinato/psicología , Revisiones Sistemáticas como Asunto , Estados Unidos , Australasia , Muerte Fetal/prevención & control , Pueblos Indígenas/psicologíaRESUMEN
BACKGROUND: International and national New Zealand (NZ) research has identified women of South Asian ethnicity at increased risk of perinatal mortality, in particular stillbirth, with calls for increased perinatal research among this ethnic group. We aimed to analyse differences in pregnancy outcomes and associated risk factors between South Asian, Maori, Pacific and NZ European women in Aotearoa NZ, with a focus on women of South Asian ethnicity, to ultimately understand the distinctive pathways leading to adverse events. METHODS: Clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, while national maternity and neonatal data, and singleton birth records from the same decade, were linked using the Statistics NZ Integrated Data Infrastructure for all births. Pregnancy outcomes and risk factors for stillbirth and neonatal death were compared between ethnicities with adjustment for pre-specified risk factors. RESULTS: Women of South Asian ethnicity were at increased risk of stillbirth (aOR 1.51, 95%CI 1.29-1.77), and neonatal death (aOR 1.51, 95%CI 1.17-1.92), compared with NZ European. The highest perinatal related mortality rates among South Asian women were between 20-23 weeks gestation (between 0.8 and 1.3/1,000 ongoing pregnancies; p < 0.01 compared with NZ European) and at term, although differences by ethnicity at term were not apparent until ≥ 41 weeks (p < 0.01). No major differences in commonly described risk factors for stillbirth and neonatal death were observed between ethnicities. Among perinatal deaths, South Asian women were overrepresented in a range of metabolic-related disorders, such as gestational diabetes, pre-existing thyroid disease, or maternal red blood cell disorders (all p < 0.05 compared with NZ European). CONCLUSIONS: Consistent with previous reports, women of South Asian ethnicity in Aotearoa NZ were at increased risk of stillbirth and neonatal death compared with NZ European women, although only at extremely preterm (< 24 weeks) and post-term (≥ 41 weeks) gestations. While there were no major differences in established risk factors for stillbirth and neonatal death by ethnicity, metabolic-related factors were more common among South Asian women, which may contribute to adverse pregnancy outcomes in this ethnic group.
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Muerte Perinatal , Mortalidad Perinatal , Personas del Sur de Asia , Mortinato , Femenino , Humanos , Recién Nacido , Embarazo , Etnicidad , Pueblo Maorí , Nueva Zelanda/epidemiología , Mortalidad Perinatal/etnología , Mortinato/epidemiología , Mortinato/etnología , Personas del Sur de Asia/estadística & datos numéricos , Sur de Asia/etnología , Resultado del Embarazo/epidemiología , Resultado del Embarazo/etnología , Factores de Riesgo , Pueblos Isleños del Pacífico , Pueblo Europeo , Mortalidad Materna/etnología , Mortalidad Infantil/etnologíaRESUMEN
BACKGROUND: Despite growing evidence suggesting racial or ethnic disparities in the risk of severe maternal morbidity among live births, there is little research investigating potential differences in severe maternal morbidity risk among stillbirths across race and ethnicity. OBJECTIVE: This study aimed to compare the risk of severe maternal morbidity by race and ethnicity among patients with singleton stillbirth pregnancies. STUDY DESIGN: We used the California Linked Birth File database to perform a retrospective analysis of singleton stillbirth pregnancies delivered at 20 to 42 weeks' gestation between 2007 and 2011. The database contained information from fetal death certificates linked to maternal hospital discharge records. We defined severe maternal morbidity using the Centers for Disease Control and Prevention composite severe maternal morbidity indicator and compared rates of severe maternal morbidity across racial and ethnic groups. Multivariable regression analysis was used to examine how race and ethnicity were associated with severe maternal morbidity risk after accounting for the influence of patients' clinical risk factors, socioeconomic characteristics, and attributes of the delivery hospital. RESULTS: Of the 9198 patients with singleton stillbirths, 533 (5.8%) experienced severe maternal morbidity. Non-Hispanic Black patients had a significantly higher risk of severe maternal morbidity (10.6% vs 5.2% in non-Hispanic White patients, 5.2% in Hispanic patients, and 5.1% in patients with other race or ethnicity; P<.001). The higher risk of severe maternal morbidity among non-Hispanic Black patients persisted even after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.74; 95% confidence interval, 1.21-2.50). Further analysis separating blood-transfusion and nontransfusion severe maternal morbidity showed a higher risk of blood transfusion in non-Hispanic Black patients, which remained significant after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.64; 95% confidence interval, 1.11-2.43). However, the higher risk of nontransfusion severe maternal morbidity in non-Hispanic Black patients was no longer significant after adjusting for patients' clinical risk factors (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.38; 95% confidence interval, 0.83-2.30). CONCLUSION: Severe maternal morbidity occurred in 5.8% of patients with a singleton stillbirth. Risk of severe maternal morbidity in stillbirth was higher in patients with non-Hispanic Black race, which was likely owing to a higher risk of hemorrhage, as evidenced by increased rate of blood transfusion.
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Negro o Afroamericano , Mortinato , Femenino , Humanos , Embarazo , Negro o Afroamericano/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Estudios Retrospectivos , Mortinato/epidemiología , Mortinato/etnología , Blanco/estadística & datos numéricos , Riesgo , California/epidemiología , Factores Socioeconómicos , Hispánicos o Latinos/estadística & datos numéricos , Factores Raciales/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricosRESUMEN
OBJECTIVE: We sought to quantify the distribution of stillbirths by gestational age (GA) in a contemporary cohort and to determine identifiable risk factors associated with stillbirth prior to 32 weeks of gestation. STUDY DESIGN: Population-based case-control study of all stillbirths in the United States during the year 2014, utilizing vital statistics data, obtained from the National Center for Health Statistics. Distribution of stillbirths were stratified by 20 to 44 weeks of GA, in women diagnosed with stillbirth in the antepartum period. Pregnancy characteristics were compared between those diagnosed with stillbirth <32 versus ≥32 weeks of gestation. Multivariate logistic regression estimated the relative influence of various factors on the outcome of stillbirth prior to 32 weeks of gestation. RESULTS: There were 15,998 nonlaboring women diagnosed with stillbirth during 2014 in the United States between 20 and 44 weeks. Of them, 60.1% (n = 9,618) occurred before antenatal fetal surveillance (ANFS) is typically initiated (<32 weeks) and 39.9% (n = 6,380) were diagnosed at ≥32 weeks. Women with stillbirth prior to 32 weeks were more likely to be of non-Hispanic Black race (29.0 vs. 23.9%, p < 0.001), nulliparous (53.8 vs. 50.6%, p = 0.001), have chronic hypertension (CHTN; 6.0 vs. 4.3%, p < 0.001), and fetal growth restriction as evidenced by small for GA (SGA < 10th%) birth weight (44.8 vs. 42.1%, p < 0.001) as opposed to women with stillbirth after 32 weeks. After adjustment, SGA birth weight (adjusted odds ratio [aOR] = 1.2, 95% confidence interval [CI]: 1.1-1.3), Black race (aOR = 1.2, 95% CI: 1.1-1.3), and CHTN (aOR = 1.3, 95% CI: 1.1-1.5) were associated with stillbirth prior to 32 weeks of gestation as opposed to stillbirth after 32 weeks. CONCLUSION: More than 6 out of 10 stillbirths in this study occurred <32 weeks of gestation, before ANFS is typically initiated under American College of Obstetricians and Gynecologists recommendations. Among identifiable risk factors, CHTN, Black race, and fetal growth restriction were associated with higher risk of stillbirth before 32 weeks of gestation. Earlier ANFS may be warranted at in certain "at risk" women. KEY POINTS: · Six out of 10 stillbirths occur before 32 weeks of gestation.. · We evaluated factors associated with stillbirth <32 weeks.. · Hypertension and fetal growth restriction were associated with early stillbirth..
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Retardo del Crecimiento Fetal , Edad Gestacional , Hipertensión , Embarazo en Diabéticas , Mortinato , Negro o Afroamericano , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Humanos , Hipertensión Inducida en el Embarazo , Recién Nacido Pequeño para la Edad Gestacional , Modelos Logísticos , Embarazo , Factores de Riesgo , Mortinato/epidemiología , Mortinato/etnología , Estados Unidos/epidemiologíaRESUMEN
Importance: Relative to what is known about pregnancy complications and sickle cell disease (SCD), little is known about the risk of pregnancy complications among those with sickle cell trait (SCT). There is a lack of clinical research among sickle cell carriers largely due to low sample sizes and disparities in research funding. Objective: To evaluate whether there is an association between SCT and a stillbirth outcome. Design, Setting, and Participants: This retrospective cohort study included data on deliveries occurring between January 1, 2010, and August 15, 2017, at 4 quaternary academic medical centers within the Penn Medicine health system in Pennsylvania. The population included a total of 2482 deliveries from 1904 patients with SCT but not SCD, and 215 deliveries from 164 patients with SCD. Data were analyzed from May 3, 2019, to September 16, 2021. Exposures: The primary exposure of interest was SCT, identified using clinical diagnosis codes recorded in the electronic health record. Main Outcomes and Measures: A multivariate logistic regression model was constructed to assess the risk of stillbirth using the following risk factors: SCD, numbers of pain crises and blood transfusions before delivery, delivery episode (as a proxy for parity), prior cesarean delivery, multiple gestation, patient age, marital status, race and ethnicity, ABO blood type, Rhesus (Rh) factor, and year of delivery. Results: This cohort study included 50â¯560 patients (63â¯334 deliveries), most of whom were aged 25 to 34 years (29â¯387 of 50â¯560 [58.1%]; mean [SD] age, 29.5 [6.1] years), were single at the time of delivery (28 186 [55.8%]), were Black or African American (23â¯777 [47.0%]), had ABO blood type O (22â¯879 [45.2%]), and were Rhesus factor positive (44â¯000 [87.0%]). From this general population, 2068 patients (4.1%) with a sickle cell gene variation were identified: 1904 patients (92.1%) with SCT (2482 deliveries) and 164 patients (7.9%) with SCD (215 deliveries). In the fully adjusted model, SCT was associated with an increased risk of stillbirth (adjusted odds ratio [aOR], 8.94; 95% CI, 1.05-75.79; P = .045) while adjusting for the risk factors of SCD (aOR, 26.40; 95% CI, 2.48-280.90; P = .007) and multiple gestation (aOR, 4.68; 95% CI, 3.48-6.29; P < .001). Conclusions and Relevance: The results of this large, retrospective cohort study indicate an increased risk of stillbirth among pregnant people with SCT. These findings underscore the need for additional risk assessment during pregnancy for sickle cell carriers.
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Complicaciones del Embarazo/genética , Rasgo Drepanocítico/complicaciones , Mortinato/epidemiología , Adulto , Población Negra/genética , Población Negra/estadística & datos numéricos , Femenino , Humanos , Modelos Logísticos , Oportunidad Relativa , Pennsylvania/epidemiología , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Rasgo Drepanocítico/etnología , Mortinato/etnología , Mortinato/genéticaRESUMEN
INTRODUCTION: Historically, stillbirth risk factors are more prevalent among non-Hispanic Black women than non-Hispanic White women, including age < 20, lower formal educational attainment, prepregnancy obesity, smoking, hypertension, diabetes, short interpregnancy interval, small for gestational age newborn, late prenatal care, and previous cesarean birth. We examined whether these disparities have changed since 2011 and identified a group of risk factors that differed between Black women and White women when accounting for correlations among variables. METHODS: In a random sample of 315 stillbirths from the National Center for Health Statistics' 2016 fetal death data, Black women and White women were compared for each risk factor using t-tests or chi-square tests. Variables with p ≤ .20 were analyzed using multivariate analysis of variance. RESULTS: In this sample, Black women experiencing stillbirth were less likely to have a Bachelor's degree (12.94% vs. 28.49%, p = .04), and more likely to be obese (44.5% vs. 29.1%, p = .01) than White women. Multivariate analysis accounting for correlations among variables showed a group of risk factors that differed between Black women and White women: age < 20, lower education, prepregnancy obesity, hypertension (chronic and pregnancy-associated), nulliparity before stillbirth, and earlier gestation. CLINICAL IMPLICATIONS: Less formal education, obesity, age <20, hypertension, chronic and pregnancy-associated, nulliparity, and earlier gestation are important to consider in multilevel stillbirth prevention interventions to decrease racial disparity in stillbirth. Respectfully listening to women and taking their concerns seriously is one way nurses and other health care providers can promote equity in health outcomes for childbearing women.
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Negro o Afroamericano/estadística & datos numéricos , Escolaridad , Disparidades en Atención de Salud , Mortinato/etnología , Población Blanca/estadística & datos numéricos , Adulto , Etnicidad , Femenino , Humanos , Recién Nacido , Embarazo , Factores de Riesgo , Mortinato/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Inasmuch as induced abortions, miscarriages and stillbirths constitute common adverse pregnancy outcomes contributing to poor maternal health, there is paucity of literature about these in Ghana. We investigated the factors associated with induced abortions, miscarriages and stillbirths in Ghana. METHODS: Data derived from the 2017 Ghana Maternal Health Survey was used in this study. Women aged 15-49 constituted the target for the study. This study examined the relationship between socio-demographic characteristics and induced abortions, stillbirths and miscarriages. Subsequently, multivariable binary logistic regression models were fitted to investigate the factors associated with induced abortions, stillbirths and miscarriages at 95 % confidence interval (CI). RESULTS: The prevalence of miscarriages, induced abortions and stillbirths in Ghana in 2017 were 10.8 %, 10.4 % and 2 % respectively. Induced abortions (12.9 %) and miscarriages (11.1 %) were found to be higher among urban residents whiles rural residents had more of stillbirths (2.1 %). Compared to women aged 15-24, those in all age categories had lower odds of experiencing induced abortions, with the lowest odds occurring among women aged 35-49 (AOR = 0.26, 95 % CI = 0.21-32). Conversely, women of all age categories had higher odds of experiencing miscarriages compared to those aged 15-24 with the highest odds among those aged 25-34 (AOR = 1.62, 95 % CI = 1.39-1.89). Women with at least primary education were more likely to experience miscarriages than those with no formal education, with those with higher level of education having the highest odds (AOR = 1.42, 95 % CI = 1.13-1.78). While the likelihood of induced abortions was lower among Muslims, compared to Christians (AOR = 0.65, 95 % CI = 0.52-0.82), the odds of miscarriages were higher among Muslims, compared to Christians (AOR = 1.31, 95 % CI = 1.13-1.52). Women with parity 1 or more were less likely to experience induced abortions, miscarriages and stillbirths compared to those with parity 0. CONCLUSIONS: Our study indicates that efforts to limit induced abortions, miscarriages and stillbirths in Ghana need to focus on the disparities in socio-demographic characteristics of women. Synergy between government health institutions and the private sector cannot be left out if much success can be achieved in efforts to subside the current prevalence of induced abortions, stillbirths and miscarriages confronting the country.
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Aborto Inducido/estadística & datos numéricos , Aborto Espontáneo/epidemiología , Escolaridad , Estado Civil , Salud Materna , Paridad , Religión , Mortinato/epidemiología , Aborto Espontáneo/etnología , Adolescente , Adulto , Factores de Edad , Etnicidad , Femenino , Ghana/epidemiología , Humanos , Modelos Logísticos , Persona de Mediana Edad , Análisis Multivariante , Embarazo , Prevalencia , Factores de Riesgo , Población Rural , Mortinato/etnología , Población Urbana , Adulto JovenRESUMEN
OBJECTIVE: To quantify how the changing stillbirth risk profile of women is affecting the interpretation of the stillbirth rate. DESIGN: A retrospective, population-based cohort study from 1983 to 2018. SETTING: Victoria, Australia. POPULATION: A total of 2 419 923 births at ≥28 weeks of gestation. METHODS: Changes in maternal characteristics over time were assessed. A multivariable logistic regression model was developed for stillbirth, based on maternal characteristics in 1983-1987, and used to calculate individual predictive probabilities of stillbirth from the regression equation. The number of expected stillbirths per year as a result of the change in maternal demographics was then calculated, assuming no changes in care and in the associations between maternal characteristics and stillbirth over time. MAIN OUTCOME MEASURE: Stillbirth. RESULTS: Compared with 1983-1987, there were more women in older age groups giving birth, more nulliparous women, more indigenous women and women born in Oceania, Asia and Africa, more multiple pregnancies and more women with pre-existing diabetes in 2014-2018. Despite this, the rate of stillbirth fell from 5.42 per 1000 births in 1983 to 1.72 per 1000 births in 2018 (P < 0.001). Applying the multivariable logistic regression equation, derived from the 1983-87 data, to each year, had there been no changes in care or in the associations between maternal characteristics and stillbirth, the rate of stillbirth would have increased by 12%, from 4.94 per 1000 in 1983 to 5.54 per 1000 in 2018, as a result of the change in maternal characteristics. CONCLUSIONS: Population rates of stillbirth are falling faster than is generally appreciated. TWEETABLE ABSTRACT: Population reductions in stillbirth have been underestimated as a result of changing maternal characteristics.
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Mortinato/epidemiología , Adulto , Femenino , Edad Gestacional , Humanos , Modelos Logísticos , Edad Materna , Paridad , Vigilancia de la Población , Embarazo , Embarazo en Diabéticas/epidemiología , Embarazo en Diabéticas/etnología , Embarazo Múltiple/etnología , Estudios Retrospectivos , Factores de Riesgo , Mortinato/etnología , Victoria/epidemiología , Adulto JovenAsunto(s)
COVID-19/epidemiología , Pandemias/estadística & datos numéricos , Nacimiento Prematuro/epidemiología , SARS-CoV-2 , Mortinato/epidemiología , COVID-19/etnología , Parto Obstétrico/estadística & datos numéricos , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Humanos , Recién Nacido , Trabajo de Parto Prematuro/epidemiología , Fenotipo , Philadelphia/epidemiología , Embarazo , Nacimiento Prematuro/etnología , Mortinato/etnologíaRESUMEN
BACKGROUND: Pakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences. METHODS: The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery, neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR), stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites. RESULTS: From 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined. The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5 per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially higher than the other sites combined. Within weight ranges, the Pakistani site generally had significantly higher rates of stillbirth and neonatal mortality than the other sites combined, with differences increasing as birthweights increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was worse than at the other sites combined. CONCLUSION: The Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these poorer outcomes likely include that the Pakistani sites' reproductive-aged women are largely poorly educated, undernourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inadequate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan's pregnancy outcomes.
Asunto(s)
Mortalidad Infantil/etnología , Mortalidad Materna/etnología , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Mortinato/etnología , Adulto , Países en Desarrollo , Femenino , Humanos , Lactante , Recién Nacido , Pakistán/epidemiología , Embarazo , Estudios Prospectivos , Mortinato/epidemiologíaRESUMEN
OBJECTIVE: To characterize stillbirths associated with pregestational diabetes and gestational diabetes mellitus (GDM) in a large, prospective, U.S. case-control study. METHODS: A secondary analysis of stillbirths among patients enrolled in a prospective; multisite; geographically, racially, and ethnically diverse case-control study in the United States was performed. Singleton gestations with complete information regarding diabetes status and with a complete postmortem evaluation were included. A standard evaluation protocol for stillbirth cases included postmortem evaluation, placental pathology, clinical testing as performed at the discretion of the health care professional, and a recommended panel of tests. A potential cause of death was assigned to stillbirth cases using a standardized classification tool. Demographic and delivery characteristics among women with pregestational diabetes and GDM were compared with characteristics of women with no diabetes in pairwise comparisons using χ or two-sample t tests as appropriate. Sensitivity analysis was performed excluding pregnancies with genetic conditions or major fetal malformations. RESULTS: Of 455 stillbirth cases included in the primary analysis, women with stillbirth and diabetes were more likely to be older than 35 years and have a higher body mass index. They were also more likely to have a gestational hypertensive disorder than women without diabetes (28% vs 9.1%; P<.001). Women with pregestational diabetes had more large-for-gestational-age (LGA) neonates (26% vs 3.4%; P<.001). Stillbirths occurred more often at term in women with pregestational diabetes (36%) and those with GDM (52%). Maternal medical complications, including pregestational diabetes and others, were more often identified as a probable or possible cause of death among stillbirths with maternal diabetes (43% vs 4%, P<.001) as compared with stillbirths without diabetes. CONCLUSION: Compared with stillbirths in women with no diabetes, stillbirths among women with pregestational diabetes and GDM occur later in pregnancy and are associated with hypertensive disorders of pregnancy, maternal medical complications, and LGA.
Asunto(s)
Diabetes Gestacional/epidemiología , Hipertensión Inducida en el Embarazo/epidemiología , Complicaciones del Embarazo/epidemiología , Embarazo en Diabéticas/epidemiología , Mortinato/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Diabetes Gestacional/etnología , Femenino , Humanos , Hipertensión Inducida en el Embarazo/etnología , Recién Nacido , Persona de Mediana Edad , Embarazo , Complicaciones del Embarazo/etnología , Embarazo en Diabéticas/etnología , Atención Prenatal , Estudios Prospectivos , Mortinato/etnología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Persistent disparities in stillbirth risk and care are present in Australia. Eliminating these disparities is possible with a commitment to enhancing and scaling up models of culturally safe maternity care shown to be effective for Aboriginal and Torres Strait Islander women and those of migrant and refugee backgrounds. Campaigns to improve public awareness of stillbirth also play an important role in reducing stillbirth risk and consequences. To achieve reach and impact in communities at risk, messaging needs to be framed around the social and cultural context of women's lives. Here we describe important initiatives underway within the Stillbirth Centre of Research Excellence to develop a coordinated national approach to stillbirth prevention and care in communities that bear a disproportionate burden of stillbirth.
Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Muerte Fetal/prevención & control , Servicios de Salud del Indígena/organización & administración , Disparidades en Atención de Salud , Servicios de Salud Materna/organización & administración , Mortinato/etnología , Australia , Competencia Cultural , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Nativos de Hawái y Otras Islas del Pacífico , Embarazo , Refugiados , MigrantesRESUMEN
BACKGROUND: Our study aims to evaluate the current perinatal registry, analyze national childbirth outcomes and study ethnic disparities in middle-income country Suriname, South America. METHODS: A nationwide birth registry study was conducted in Suriname. Data were collected for 2016 and 2017 from the childbirth books of all five hospital maternity wards, covering 86% of all births in the country. Multinomial regression analyses were used to assess ethnic disparities in outcomes of maternal deaths, stillbirths, teenage pregnancy, cesarean delivery, low birth weight and preterm birth with Hindustani women as reference group. RESULTS: 18.290 women gave birth to 18.118 (98%) live born children in the five hospitals. Hospital-based maternal mortality ratio was 112 per 100.000 live births. Hospital-based late stillbirth rate was 16 per 1000 births. Stillbirth rate was highest among Maroon (African-descendent) women (25 per 1000 births, aOR 2.0 (95%CI 1.3-2.8) and lowest among Javanese women (6 stillbirths per 1000 births, aOR 0.5, 95%CI 0.2-1.2). Preterm birth and low birthweight occurred in 14 and 15% of all births. Teenage pregnancy accounted for 14% of all births and was higher in Maroon women (18%) compared to Hindustani women (10%, aOR 2.1, 95%CI 1.8-2.4). The national cesarean section rate was 24% and was lower in Maroon (17%) than in Hindustani (32%) women (aOR 0.5 (95%CI 0.5-0.6)). Cesarean section rates varied between the hospitals from 17 to 36%. CONCLUSION: This is the first nationwide comprehensive overview of maternal and perinatal health in a middle income country. Disaggregated perinatal health data in Suriname shows substantial inequities in outcomes by ethnicity which need to be targetted by health professionals, researchers and policy makers.
Asunto(s)
Parto Obstétrico/mortalidad , Mortalidad Materna , Parto , Complicaciones del Embarazo/mortalidad , Adolescente , Adulto , Cesárea , Etnicidad , Femenino , Disparidades en el Estado de Salud , Humanos , Edad Materna , Embarazo , Complicaciones del Embarazo/etnología , Resultado del Embarazo , Nacimiento Prematuro/etnología , Nacimiento Prematuro/mortalidad , Sistema de Registros , Factores de Riesgo , Mortinato/etnología , Suriname , Adulto JovenRESUMEN
BACKGROUND: Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS: A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Maori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Maori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Maori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION: Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.
Asunto(s)
Emigrantes e Inmigrantes , Emigración e Inmigración , Conocimientos, Actitudes y Práctica en Salud/etnología , Recursos en Salud , Disparidades en Atención de Salud/etnología , Servicios de Salud Materna , Aceptación de la Atención de Salud/etnología , Mortinato/etnología , Adulto , Pueblo Asiatico , Población Negra , Recursos en Salud/tendencias , Disparidades en Atención de Salud/tendencias , Humanos , Servicios de Salud Materna/tendencias , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico , Educación del Paciente como Asunto/tendencias , Factores Raciales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Australia Occidental/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Parental exposure to tobacco smoke has been associated with an increased risk of stillbirth, while only a few studies took the overall parental tobacco exposure status into consideration. We aim to explore the relationship of parental smoking and passive smoking before and during pregnancy with stillbirth in a large Chinese rural cohort. DESIGN: 248 501 couples were enrolled in a national prospective cohort study conducted in rural China. Parental exposure to tobacco smoke before and during pregnancy, along with other risk factors, was ascertained by questionnaires. Pregnancy outcomes were recorded by physicians. RESULTS: The ORs (Odds Ratios) of maternal active smoking, maternal passive smoking, paternal active smoking and paternal passive smoking were 2.07 (95% CI 1.25 to 3.41), 1.22 (95% CI 1.01 to 1.47), 1.36 (95% CI 1.13 to 1.63) and 1.10 (95% CI 0.87 to 1.39), respectively. The rates of stillbirth increased from 0.31% for the maternal non-smoking group to 0.43% for the smoking cessation during pregnancy group, to 0.64% for the decreased smoking group and 1.28% for the continuing smoking group. A similar pattern was found in the change in paternal smoking status and stillbirth. Stratified by maternal passive smoking, the OR of paternal smoking was 1.35 (95% CI 1.13 to 1.61) in the maternal non-smoking group and 1.67 (95% CI 1.09 to 2.56) in the maternal passive smoking group. CONCLUSIONS: Parental exposure to tobacco smoke increased the risk of stillbirth, especially for those continuing smoking during pregnancy. Paternal smoking is an independent risk factor for stillbirth despite maternal passive smoking status.
Asunto(s)
Exposición Materna/efectos adversos , Efectos Tardíos de la Exposición Prenatal/epidemiología , Mortinato/epidemiología , Contaminación por Humo de Tabaco/efectos adversos , China/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Vigilancia de la Población , Embarazo , Resultado del Embarazo , Estudios Prospectivos , Vigilancia en Salud Pública , Factores de Riesgo , Población Rural , Mortinato/etnologíaRESUMEN
INTRODUCTION: Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women's ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women's empowerment is associated with stillbirths. METHODS: Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women's empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted. RESULTS: A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22-4.80). Education of mother (aOR 1.48; 0.94-2.33), age of husband (aOR 1.54; 0.86-2.76), household head (aOR 1.51; 0.88-2.59), poor wealth index (aOR 1.62; 0.98-2.68), middle wealth index (aOR 1.37; 0.76-2.47), decision making for healthcare (aOR 1.36; 0.84-2.21) and household purchases (aOR 1.01; 0.61-1.66) had no any significant association with stillbirths. CONCLUSIONS: There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.