Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation
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 th...
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| description | 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 ( |
| doi_str_mv | 10.1001/jama.2011.1798 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3807602</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>1104721</ama_id><sourcerecordid>920794829</sourcerecordid><originalsourceid>FETCH-LOGICAL-a497t-a27fa72257ce27097f9420702b2536b44717d49cb25fc50c5e569739b7650613</originalsourceid><addsrcrecordid>eNpdkctvVCEUh4nR2LG6deHCEJPG1R15PzYmdWLV2KRGuydchtsy3gsVmDb97-U64_hgQwgfP845HwDPMVpihPCbjZ3skiCMl1hq9QAsMKeqo1yrh2CBkFadZIodgSelbFBbmMrH4IgQLIRAYgEuTktJLtgaUoTvfL3zPsJvNYxjH3K9hjau4ddQvsMz62rKBX6O6S5CW-GX7K-ije4erlIcQp5-ZTwFjwY7Fv9svx-Dy7P3l6uP3fnFh0-r0_POMi1rZ4kcrCSES-eJRFoOmhEkEekJp6JnTGK5Ztq14-A4ctxzoSXVvRQcCUyPwdtd7M22n_za-VizHc1NDpPN9ybZYP69ieHaXKVbQxWSApEW8HofkNOPrS_VTKE4P442-rQtRrdqNFNEN_LVf-QmbXNszRmNGeZC0Rla7iCXUynZD4dSMDKzKDOLMrMoM4tqD17-3cAB_22mASd7wBZnxyG3UYfyh-NEYYrmSbzYcXP-4VOMmCSY_gTrF6Nw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>914156839</pqid></control><display><type>article</type><title>Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation</title><source>MEDLINE</source><source>American Medical Association Journals</source><creatorcontrib>Stillbirth Collaborative Research Network Writing Group</creatorcontrib><description>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.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2011.1798</identifier><identifier>PMID: 22166606</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; African Americans - statistics & numerical data ; Biological and medical sciences ; Blood Group Antigens ; Case-Control Studies ; Epidemiology ; European Continental Ancestry Group - statistics & numerical data ; Female ; General aspects ; Health Status Disparities ; Healthcare Disparities ; Humans ; Maternal & child health ; Maternal Age ; Medical sciences ; Odds Ratio ; Parity ; Pregnancy ; Pregnancy Complications ; Pregnancy Tests ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk Factors ; Smoking ; Stillbirth ; Stillbirth - epidemiology ; Stillbirth - ethnology ; Substance-Related Disorders ; United States - epidemiology ; Young Adult</subject><ispartof>JAMA : the journal of the American Medical Association, 2011-12, Vol.306 (22), p.2469-2479</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Medical Association Dec 14, 2011</rights><rights>2011 American Medical Association. All rights reserved. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a497t-a27fa72257ce27097f9420702b2536b44717d49cb25fc50c5e569739b7650613</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.2011.1798$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2011.1798$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,776,780,881,3327,27901,27902,76232,76235</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25281301$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22166606$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stillbirth Collaborative Research Network Writing Group</creatorcontrib><title>Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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.</description><subject>Adult</subject><subject>African Americans - statistics & numerical data</subject><subject>Biological and medical sciences</subject><subject>Blood Group Antigens</subject><subject>Case-Control Studies</subject><subject>Epidemiology</subject><subject>European Continental Ancestry Group - statistics & numerical data</subject><subject>Female</subject><subject>General aspects</subject><subject>Health Status Disparities</subject><subject>Healthcare Disparities</subject><subject>Humans</subject><subject>Maternal & child health</subject><subject>Maternal Age</subject><subject>Medical sciences</subject><subject>Odds Ratio</subject><subject>Parity</subject><subject>Pregnancy</subject><subject>Pregnancy Complications</subject><subject>Pregnancy Tests</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Risk Factors</subject><subject>Smoking</subject><subject>Stillbirth</subject><subject>Stillbirth - epidemiology</subject><subject>Stillbirth - ethnology</subject><subject>Substance-Related Disorders</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkctvVCEUh4nR2LG6deHCEJPG1R15PzYmdWLV2KRGuydchtsy3gsVmDb97-U64_hgQwgfP845HwDPMVpihPCbjZ3skiCMl1hq9QAsMKeqo1yrh2CBkFadZIodgSelbFBbmMrH4IgQLIRAYgEuTktJLtgaUoTvfL3zPsJvNYxjH3K9hjau4ddQvsMz62rKBX6O6S5CW-GX7K-ije4erlIcQp5-ZTwFjwY7Fv9svx-Dy7P3l6uP3fnFh0-r0_POMi1rZ4kcrCSES-eJRFoOmhEkEekJp6JnTGK5Ztq14-A4ctxzoSXVvRQcCUyPwdtd7M22n_za-VizHc1NDpPN9ybZYP69ieHaXKVbQxWSApEW8HofkNOPrS_VTKE4P442-rQtRrdqNFNEN_LVf-QmbXNszRmNGeZC0Rla7iCXUynZD4dSMDKzKDOLMrMoM4tqD17-3cAB_22mASd7wBZnxyG3UYfyh-NEYYrmSbzYcXP-4VOMmCSY_gTrF6Nw</recordid><startdate>20111214</startdate><enddate>20111214</enddate><creator>Stillbirth Collaborative Research Network Writing Group</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7U1</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>20111214</creationdate><title>Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation</title></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a497t-a27fa72257ce27097f9420702b2536b44717d49cb25fc50c5e569739b7650613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>African Americans - statistics & numerical data</topic><topic>Biological and medical sciences</topic><topic>Blood Group Antigens</topic><topic>Case-Control Studies</topic><topic>Epidemiology</topic><topic>European Continental Ancestry Group - statistics & numerical data</topic><topic>Female</topic><topic>General aspects</topic><topic>Health Status Disparities</topic><topic>Healthcare Disparities</topic><topic>Humans</topic><topic>Maternal & child health</topic><topic>Maternal Age</topic><topic>Medical sciences</topic><topic>Odds Ratio</topic><topic>Parity</topic><topic>Pregnancy</topic><topic>Pregnancy Complications</topic><topic>Pregnancy Tests</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Risk Factors</topic><topic>Smoking</topic><topic>Stillbirth</topic><topic>Stillbirth - epidemiology</topic><topic>Stillbirth - ethnology</topic><topic>Substance-Related Disorders</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stillbirth Collaborative Research Network Writing Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><aucorp>Stillbirth Collaborative Research Network Writing Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2011-12-14</date><risdate>2011</risdate><volume>306</volume><issue>22</issue><spage>2469</spage><epage>2479</epage><pages>2469-2479</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><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.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>22166606</pmid><doi>10.1001/jama.2011.1798</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | JAMA : the journal of the American Medical Association, 2011-12, Vol.306 (22), p.2469-2479 |
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| subjects | Adult African Americans - statistics & numerical data Biological and medical sciences Blood Group Antigens Case-Control Studies Epidemiology European Continental Ancestry Group - statistics & numerical data Female General aspects Health Status Disparities Healthcare Disparities Humans Maternal & child health Maternal Age Medical sciences Odds Ratio Parity Pregnancy Pregnancy Complications Pregnancy Tests Public health. Hygiene Public health. Hygiene-occupational medicine Risk Factors Smoking Stillbirth Stillbirth - epidemiology Stillbirth - ethnology Substance-Related Disorders United States - epidemiology Young Adult |
| title | Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation |
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