Stillbirths: Contribution of preterm birth and size‐for‐gestational age for 125.4 million total births from nationwide records in 13 countries, 2000–2020

Author:

Okwaraji Yemisrach B.1ORCID,Suárez‐Idueta Lorena2ORCID,Ohuma Eric O.1ORCID,Bradley Ellen1ORCID,Yargawa Judith1ORCID,Pingray Veronica3ORCID,Cormick Gabriela34,Gordon Adrienne5ORCID,Flenady Vicki5ORCID,Horváth‐Puhó Erzsébet6ORCID,Sørensen Henrik Toft6ORCID,Sakkeus Luule7ORCID,Abuladze Liili78ORCID,Heidarzadeh Mohammed9ORCID,Khalili Narjes10ORCID,Yunis Khalid A.11ORCID,Al Bizri Ayah11ORCID,Karalasingam Shamala D.12ORCID,Jeganathan Ravichandran13ORCID,Barranco Arturo14,van Dijk Aimée E.15,Broeders Lisa15,Alyafei Fawzya16ORCID,AlQubaisi Mai17,Razaz Neda18ORCID,Söderling Jonas18ORCID,Smith Lucy K.19ORCID,Matthews Ruth J.19,Wood Rachael2021ORCID,Monteath Kirsten22,Pereyra Isabel23ORCID,Pravia Gabriella24ORCID,Lisonkova Sarka2526ORCID,Wen Qi25,Lawn Joy E.1ORCID,Blencowe Hannah1ORCID,

Affiliation:

1. Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre London School of Hygiene & Tropical Medicine London UK

2. Mexican Society of Public Health Mexico City Mexico

3. Institute for Clinical Effectiveness and Health Policy Ciudad Autónoma de Buenos Aires Argentina

4. Centro de Investigaciones en Epidemiología y Salud Pública, National Scientific and Technical Research Council (CONICET) Ciudad Autónoma de Buenos Aires Argentina

5. Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia

6. Department of Clinical Epidemiology Aarhus University and Aarhus University Hospital Aarhus N Denmark

7. School of Governance, Law and Society, Estonian Institute for Population Studies Tallinn University Tallinn Estonia

8. Population Research Unit Väestöliitto Finland

9. Paediatrics Department Alzahra Hospital Iran Tabriz Iran

10. Department of Community and Family Medicine, Preventive Medicine and Public Health Research Centre, Psychosocial Health Research Institute, School of Medicine Iran University of Medical Sciences Tehran Iran

11. Division of Neonatology, Department of Pediatrics and Adolescent Medicine American University of Beirut Beirut Lebanon

12. Department of Obstetrics and Gynaecology, Faculty of Medicine University of Cyberjaya Cyberjaya Malaysia

13. Department of Obstetrics & Gynaecology Malaysia Monash Medical School Johor Bahru Malaysia

14. Directorate of Health Information Ministry of Health Mexico City Mexico

15. Perined Utrecht The Netherlands

16. Department of Paediatrics Hamad General Hospital Doha Qatar

17. NICU, Women Wellness and Research Centre Doha Qatar

18. Clinical Epidemiology Division, Department of Medicine Solna Karolinska Institute Stockholm Sweden

19. Department of Population Health Sciences, College of Life Sciences University of Leicester Leicester UK

20. Public Health Scotland Edinburgh UK

21. Usher Institute University of Edinburgh Edinburgh UK

22. Pregnancy, Birth and Child Health Team Public Health Scotland Edinburgh UK

23. Faculty of Health Sciences Catholic University of Maule Curicó Chile

24. Department of Wellness and Health Catholic University of Uruguay Montevideo Uruguay

25. Department of Obstetrics & Gynaecology University of British Columbia Vancouver British Columbia Canada

26. School of Population and Public Health University of British Columbia Vancouver British Columbia Canada

Abstract

AbstractObjectiveTo examine the contribution of preterm birth and size‐for‐gestational age in stillbirths using six ‘newborn types’.DesignPopulation‐based multi‐country analyses.SettingBirths collected through routine data systems in 13 countries.Sample125 419 255 total births from 22+0 to 44+6 weeks’ gestation identified from 2000 to 2020.MethodsWe included 635 107 stillbirths from 22+0 weeks’ gestation from 13 countries. We classified all births, including stillbirths, into six ‘newborn types’ based on gestational age information (preterm, PT, <37+0 weeks versus term, T, ≥37+0 weeks) and size‐for‐gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th–90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH‐21st standards.Main outcome measuresDistribution of stillbirths, stillbirth rates and rate ratios according to six newborn types.Results635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22+0 weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8–118.8) followed by PT + AGA (RR 25.0, IQR, 20.0–34.3), PT + LGA (RR 25.9, IQR, 13.8–28.7) and T + SGA (RR 5.6, IQR, 5.1–6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7–1.1). At the population level, 25% of stillbirths were attributable to small‐for‐gestational‐age.ConclusionsIn these high‐quality data from high/middle income countries, almost three‐quarters of stillbirths were born preterm and a fifth small‐for‐gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation‐specific risk in these populations, as well as patterns in lower‐income contexts, especially those with higher rates of intrapartum stillbirth and SGA.

Funder

Children's Investment Fund Foundation

Publisher

Wiley

Subject

Obstetrics and Gynecology

Reference37 articles.

1. UNICEF. United Nations Inter‐agency Group for Child Mortality Estimation (UN IGME).Levels & trends in child mortality: report 2020. Estimates developed by the United Nations Inter‐Agency Group for Child Mortality Estimation.2020.

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