Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting

Lesley ME McCOWAN, Maha GEORGE-HADDAD, Tomasina Stacey, John Thompson

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Stillbirth affects almost 1% of pregnant women in the Western world but is still not a research priority. Aims: To assess in a cohort of stillbirths: the demographic risk factors, the prevalence of small for gestational age (SGA) by customised and population centiles, and the classification of death using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ‐PDC). Methods: The study population comprised 437 stillborn babies (born from 1993 to 2000 at National Women's Hospital, Auckland, New Zealand) and their mothers. The referent population for demographic factors was live births n = 69 173. Results: After multivariable analysis, risk factors for stillbirths were: Indian (odds ratio (OR) 1.85, 95%CI (1.18, 2.91)), or Pacific Islander (OR 1.65, 95%CI (1.27, 2.14)); smoking (OR 1.33, 95%CI (0.99, 1.79)) or unknown smoking status (OR 2.87, 95%CI (2.30, 3.58)); nulliparity (OR 1.42, 95%CI (1.10, 1.83)), and para 2 (OR 1.36, 95%CI (1.01, 1.83)). One hundred and twenty‐nine (46%) stillbirths born ≥ 24 weeks (n = 278) were SGA by customised, and 94 (34%) by population centiles. Customised SGA was more common in preterm versus term stillbirths (101 of 198 (51%) vs 28 of 80 (35%), respectively, P = 0.02) but rates of population SGA did not differ (72 of 198 (36%) vs 22 of 80 (28%) P = 0.16). ‘Spontaneous preterm’ was the most common cause of stillbirth at < 28 weeks and ‘unexplained’ at ≥ 28 weeks using PSANZ‐PDC classification. Conclusions: This study again emphasises the importance of suboptimal fetal growth as an important risk factor for stillbirth. Customised centiles identified more stillborn babies as SGA than population centiles especially preterm.
LanguageEnglish
Pages450-456
Number of pages7
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Volume47
Issue number6
Early online date6 Nov 2007
DOIs
Publication statusPublished - 1 Dec 2007
Externally publishedYes

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Stillbirth
Fetal Development
New Zealand
Gestational Age
Odds Ratio
Population
Smoking
Demography
Western World
Live Birth
Parity
Pregnant Women
Mothers
Research

Cite this

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title = "Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting",
abstract = "Background: Stillbirth affects almost 1{\%} of pregnant women in the Western world but is still not a research priority. Aims: To assess in a cohort of stillbirths: the demographic risk factors, the prevalence of small for gestational age (SGA) by customised and population centiles, and the classification of death using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ‐PDC). Methods: The study population comprised 437 stillborn babies (born from 1993 to 2000 at National Women's Hospital, Auckland, New Zealand) and their mothers. The referent population for demographic factors was live births n = 69 173. Results: After multivariable analysis, risk factors for stillbirths were: Indian (odds ratio (OR) 1.85, 95{\%}CI (1.18, 2.91)), or Pacific Islander (OR 1.65, 95{\%}CI (1.27, 2.14)); smoking (OR 1.33, 95{\%}CI (0.99, 1.79)) or unknown smoking status (OR 2.87, 95{\%}CI (2.30, 3.58)); nulliparity (OR 1.42, 95{\%}CI (1.10, 1.83)), and para 2 (OR 1.36, 95{\%}CI (1.01, 1.83)). One hundred and twenty‐nine (46{\%}) stillbirths born ≥ 24 weeks (n = 278) were SGA by customised, and 94 (34{\%}) by population centiles. Customised SGA was more common in preterm versus term stillbirths (101 of 198 (51{\%}) vs 28 of 80 (35{\%}), respectively, P = 0.02) but rates of population SGA did not differ (72 of 198 (36{\%}) vs 22 of 80 (28{\%}) P = 0.16). ‘Spontaneous preterm’ was the most common cause of stillbirth at < 28 weeks and ‘unexplained’ at ≥ 28 weeks using PSANZ‐PDC classification. Conclusions: This study again emphasises the importance of suboptimal fetal growth as an important risk factor for stillbirth. Customised centiles identified more stillborn babies as SGA than population centiles especially preterm.",
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Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting. / McCOWAN, Lesley ME; GEORGE-HADDAD, Maha; Stacey, Tomasina; Thompson, John.

In: Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 47, No. 6, 01.12.2007, p. 450-456.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting

AU - McCOWAN, Lesley ME

AU - GEORGE-HADDAD, Maha

AU - Stacey, Tomasina

AU - Thompson, John

PY - 2007/12/1

Y1 - 2007/12/1

N2 - Background: Stillbirth affects almost 1% of pregnant women in the Western world but is still not a research priority. Aims: To assess in a cohort of stillbirths: the demographic risk factors, the prevalence of small for gestational age (SGA) by customised and population centiles, and the classification of death using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ‐PDC). Methods: The study population comprised 437 stillborn babies (born from 1993 to 2000 at National Women's Hospital, Auckland, New Zealand) and their mothers. The referent population for demographic factors was live births n = 69 173. Results: After multivariable analysis, risk factors for stillbirths were: Indian (odds ratio (OR) 1.85, 95%CI (1.18, 2.91)), or Pacific Islander (OR 1.65, 95%CI (1.27, 2.14)); smoking (OR 1.33, 95%CI (0.99, 1.79)) or unknown smoking status (OR 2.87, 95%CI (2.30, 3.58)); nulliparity (OR 1.42, 95%CI (1.10, 1.83)), and para 2 (OR 1.36, 95%CI (1.01, 1.83)). One hundred and twenty‐nine (46%) stillbirths born ≥ 24 weeks (n = 278) were SGA by customised, and 94 (34%) by population centiles. Customised SGA was more common in preterm versus term stillbirths (101 of 198 (51%) vs 28 of 80 (35%), respectively, P = 0.02) but rates of population SGA did not differ (72 of 198 (36%) vs 22 of 80 (28%) P = 0.16). ‘Spontaneous preterm’ was the most common cause of stillbirth at < 28 weeks and ‘unexplained’ at ≥ 28 weeks using PSANZ‐PDC classification. Conclusions: This study again emphasises the importance of suboptimal fetal growth as an important risk factor for stillbirth. Customised centiles identified more stillborn babies as SGA than population centiles especially preterm.

AB - Background: Stillbirth affects almost 1% of pregnant women in the Western world but is still not a research priority. Aims: To assess in a cohort of stillbirths: the demographic risk factors, the prevalence of small for gestational age (SGA) by customised and population centiles, and the classification of death using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ‐PDC). Methods: The study population comprised 437 stillborn babies (born from 1993 to 2000 at National Women's Hospital, Auckland, New Zealand) and their mothers. The referent population for demographic factors was live births n = 69 173. Results: After multivariable analysis, risk factors for stillbirths were: Indian (odds ratio (OR) 1.85, 95%CI (1.18, 2.91)), or Pacific Islander (OR 1.65, 95%CI (1.27, 2.14)); smoking (OR 1.33, 95%CI (0.99, 1.79)) or unknown smoking status (OR 2.87, 95%CI (2.30, 3.58)); nulliparity (OR 1.42, 95%CI (1.10, 1.83)), and para 2 (OR 1.36, 95%CI (1.01, 1.83)). One hundred and twenty‐nine (46%) stillbirths born ≥ 24 weeks (n = 278) were SGA by customised, and 94 (34%) by population centiles. Customised SGA was more common in preterm versus term stillbirths (101 of 198 (51%) vs 28 of 80 (35%), respectively, P = 0.02) but rates of population SGA did not differ (72 of 198 (36%) vs 22 of 80 (28%) P = 0.16). ‘Spontaneous preterm’ was the most common cause of stillbirth at < 28 weeks and ‘unexplained’ at ≥ 28 weeks using PSANZ‐PDC classification. Conclusions: This study again emphasises the importance of suboptimal fetal growth as an important risk factor for stillbirth. Customised centiles identified more stillborn babies as SGA than population centiles especially preterm.

KW - growth restriction

KW - perinatal death

KW - small for gestational age

KW - stillbirth

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DO - 10.1111/j.1479-828X.2007.00778.x

M3 - Article

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JO - Australian and New Zealand Journal of Obstetrics and Gynaecology

T2 - Australian and New Zealand Journal of Obstetrics and Gynaecology

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SN - 0004-8666

IS - 6

ER -