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Clinical Obstetrics and Gynecology Mar 2016In the United States, roughly half of women are either overweight (24.5%) or obese (21.4%) when they become pregnant. Women who are obese before pregnancy are at... (Review)
Review
In the United States, roughly half of women are either overweight (24.5%) or obese (21.4%) when they become pregnant. Women who are obese before pregnancy are at increased risk for a number of pregnancy complications relative to normal-weight women. Specifically, obesity is associated with significantly increased maternal risks, including gestational diabetes mellitus, hypertensive disorders of pregnancy, and sleep disordered breathing. Maternal obesity is also associated with increased risks of adverse fetal outcomes, including prematurity, stillbirth, congenital anomalies, and abnormal fetal growth. In this review, we will discuss the implications of obesity with respect to antepartum care.
Topics: Abortion, Spontaneous; Body Fat Distribution; Congenital Abnormalities; Continuous Positive Airway Pressure; Diabetes, Gestational; Female; Humans; Obesity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Prenatal Care; Sleep Apnea, Obstructive; Stillbirth; Weight Gain
PubMed: 26756260
DOI: 10.1097/GRF.0000000000000173 -
BJOG : An International Journal of... Oct 2021To evaluate the recurrence risk of stillbirth.
OBJECTIVES
To evaluate the recurrence risk of stillbirth.
DESIGN
Retrospective cohort study.
SETTING AND POPULATION
All births 1992-2017, Alberta, Canada.
METHODS
Retrospective cohort study.
MAIN OUTCOME MEASURES
Stillbirth was defined as the death in utero of a fetus with gestational age ≥20 weeks or weighing ≥500 g. Stillbirths were further subdivided into those occurring before labour and those in labour.
RESULTS
We identified 744 897 births from 308 478 women. Of these, 3698 women experienced a stillbirth and, of these, 97.7%, experienced only one. For women with a small-for-gestational- age stillbirth in the first birth, their risk of a subsequent antepartum stillbirth was increased substantially: 4.09%, relative risk (RR) 10.39, 95% CI 5.81-18.59. For women with a first birth appropriate-for-gestational-age stillbirth with no risk factors such as pregnancy induced hypertension, the risk with pre-existing diabetes mellitus or hypertension was also increased but to a much lesser degree (RR 2.46, 95% CI 1.23-4.91). For women who had experienced a first birth intrapartum stillbirth, the risk of another intrapartum stillbirth was very high (3.59%, RR 36.50, 95% CI 20.17-66.05). Most of these births also occurred prior to 24 weeks' gestation: 83% (10/12).
CONCLUSIONS
The risk of recurrent antepartum stillbirth is low. The increase in risk in instances where the antepartum stillbirth was not growth-restricted is not clinically meaningful. Given the very low risk in any given gestational week, fetal surveillance is unlikely to be effective and may lead to unnecessary interventions. Intrapartum stillbirth has a very high recurrence risk but may not be preventable.
TWEETABLE ABSTRACT
Stillbirth recurrence is rare.
Topics: Adult; Alberta; Female; Fetal Death; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Pregnancy; Prenatal Care; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Stillbirth
PubMed: 33837600
DOI: 10.1111/1471-0528.16718 -
American Journal of Obstetrics and... Jun 2007To examine disparities in risk factors for stillbirths and its occurrence in the antepartum versus intrapartum periods. A population-based, cross-sectional study using...
To examine disparities in risk factors for stillbirths and its occurrence in the antepartum versus intrapartum periods. A population-based, cross-sectional study using data on women that delivered singleton births between 20 and 43 weeks in Missouri (1989-1997) was conducted (n = 626,883). Hazard ratios and 95% confidence intervals were derived from regression models and population attributable fractions were estimated to examine the impact of risk factors on stillbirth. Among African Americans, risks of antepartum and intrapartum stillbirth were 5.6 and 1.1 per 1,000 singleton births, respectively; risks among whites were 3.4 and 0.5 per 1,000 births, respectively. Maternal age > or = 35 years, lack of prenatal care, prepregnancy body mass index (BMI) > or = 30 kg/m2, and prior preterm or small-for-gestational age birth were significantly associated with increased risk for antepartum stillbirth among whites, but not African Americans. BMI < or = 18.5 kg/m2 was associated with antepartum and intrapartum stillbirth among African Americans, but not whites. The presence of any congenital anomaly, abruption, and cord complications were associated with antepartum stillbirth in both races. Premature rupture of membranes was associated with intrapartum stillbirth among whites and African Americans, but intrapartum fever was associated with intrapartum stillbirth among African Americans. These risk factors were implicated in 54.9% and 19.7% of antepartum and intrapartum stillbirths, respectively, among African American women, and in a respective 46.6% and 11.9% among white women. Considerable heterogeneity in risk factors between antepartum and intrapartum stillbirths is evident. Knowledge on timing of stillbirth specific risk factors may help clinicians in decreasing antepartum and intrapartum stillbirth risks through monitoring and timely intervention.
Topics: Abruptio Placentae; Black People; Body Mass Index; Congenital Abnormalities; Cross-Sectional Studies; Female; Fetal Membranes, Premature Rupture; Fever; Humans; Hypertension; Infant, Newborn; Infant, Small for Gestational Age; Kidney Diseases; Maternal Age; Missouri; Pregnancy; Premature Birth; Prenatal Care; Proportional Hazards Models; Risk Factors; Stillbirth; Umbilical Cord; Uterine Hemorrhage; White People
PubMed: 17547873
DOI: 10.1016/j.ajog.2006.09.017 -
BJOG : An International Journal of... Jan 2024To investigate the incidence of antepartum stillbirth in relation to the distribution of neonatal/fetal weight for different gestational ages. (Observational Study)
Observational Study
OBJECTIVES
To investigate the incidence of antepartum stillbirth in relation to the distribution of neonatal/fetal weight for different gestational ages.
DESIGN
Prospective observational cohort study.
SETTING
Obstetric ultrasound departments in two UK maternity hospitals.
POPULATION
168 966 women with singleton pregnancies attending for routine antenatal care.
METHODS
We examined the incidence of antepartum stillbirths, within different birthweight and fetal weight percentile subgroups, conditioning for gestational age.
MAIN OUTCOME MEASURES
Incidence of antepartum stillbirth.
RESULTS
The risk of stillbirth progressively increased for lower birthweight. Considering the 25-75th percentile as the reference category, the relative risks for stillbirth at <37 weeks' gestation were 7.6 (95% confidence interval [CI] 5.7-10.2) <1st percentile, 2.6 (95% CI 1.8-3.7) 1 to 10th percentile, 1.4 (95% CI 0.9-2.1) 10 to 25th percentile, 0.8 (95% CI 0.4-1.5) 75 to 90th percentile, 0.8 (95% CI 0.4-1.7) 90 to 99th percentile, 0.9 (95% CI 0.3-2.5) >99th percentile. The respective values for births at ≥37 weeks' gestation were 5.0 (95% CI 2.9-8.9), 2.1 (95% CI 1.4-3.3), 1.4 (95% CI 0.9-2.1), 1.2 (95% CI 0.7-1.8), 1.0 (95% CI 0.6-1.8) and 4.0 (95% CI 1.8-9.3). The incidence of stillbirth in ongoing low-risk singleton pregnancies gradually increases for smaller fetuses at any gestational point. The higher incidence (5.56%) was evident for fetal weight <1st percentile between 24 and 28 weeks' gestation.
CONCLUSION
Fetal weight and the weight of the stillborn have a continuous association with the incidence of antepartum stillbirth which is affected by gestational age.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Birth Weight; Stillbirth; Gestational Age; Prospective Studies; Fetal Weight; Infant, Small for Gestational Age; Fetal Growth Retardation
PubMed: 37691257
DOI: 10.1111/1471-0528.17652 -
BMC Pregnancy and Childbirth Jul 2015Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has...
BACKGROUND
Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting.
METHODS
This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth.
RESULTS
During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-for-gestational age babies (aOR 1.5, 95 % CI 1.2-2.0).
CONCLUSION
Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome.
CLINICAL TRIAL REGISTRATION
ISRCTN97846009 (url. www.isrctn.com/ISRCTN97846009 ).
Topics: Adult; Case-Control Studies; Educational Status; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Infant, Small for Gestational Age; Logistic Models; Maternal Age; Nepal; Parity; Pregnancy; Prenatal Care; Risk Factors; Socioeconomic Factors; Stillbirth; Young Adult
PubMed: 26143456
DOI: 10.1186/s12884-015-0567-3 -
Placenta Apr 2013Unexplained antepartum stillbirth is a major obstetric health problem. Data demonstrate a rapid rise in risk per 1000 continuing pregnancies as gestation advances beyond...
Unexplained antepartum stillbirth is a major obstetric health problem. Data demonstrate a rapid rise in risk per 1000 continuing pregnancies as gestation advances beyond 40 weeks. We review the evidence that such stillbirths are a consequence of aging related changes in the late gestation placenta. We suggest that the relatively small number of continuing pregnancies after 40 completed weeks means that negative effects of genes that produce aging affect so few pregnancies that polymorphisms in genes that produce these effects are retained in the population. Aging related changes likely represent a consequence of the damaging effects of oxidative stress, increased by cigarette smoking counteracted by the mitigating effects of oxidative defence pathways. The aging related changes are likely downstream from nutrient sensing units such as mTOR and include effects on production of telomerase and consequent shortening of telomere length. The late gestation changes occur in the context of increasing fetal growth and nutrient supply demands that can produce the rapid development of a mismatch between placental supply and fetal need resulting in fetal demise. Premature aging may also play an important role in antepartum stillbirth occurring earlier in pregnancy, especially in the context of growth restriction.
Topics: Aging; Female; Fetal Death; Gestational Age; Humans; Placenta; Pregnancy; Stillbirth
PubMed: 23452441
DOI: 10.1016/j.placenta.2013.01.015 -
BMC Pregnancy and Childbirth Jul 2021Antepartum stillbirth, i.e., intrauterine fetal death (IUFD) above 24 weeks of gestation, occurs with a prevalence of 2.4-3.1 per 1000 live births in Central Europe. In...
BACKGROUND
Antepartum stillbirth, i.e., intrauterine fetal death (IUFD) above 24 weeks of gestation, occurs with a prevalence of 2.4-3.1 per 1000 live births in Central Europe. In order to ensure highest standards of treatment and identify causative and associated (risk) factors for fetal death, evidence-based guidelines on clinical practice in such events are recommended. Owing to a lack of a national guideline on maternal care and investigations following stillbirth, we, hereby, sought to assess the use of institutional guidelines and clinical practice after IUFD in Austrian maternity units.
METHODS
A national survey with a paper-based 12-item questionnaire covering demographic variables, local facilities and practice, obstetrical care and routine post-mortem work-up following IUFD was performed among all Austrian secondary and tertiary referral hospitals with maternity units (n = 75) between January and July 2019. Statistical tests were conducted using Chi and Fisher's Exact test, respectively. Univariate logistic regression analyses were performed to calculate odds ratio (OR) with a 95% confidence interval (CI).
RESULTS
46 (61.3%) obstetrical departments [37 (80.4%) secondary; 9 (19.6%) tertiary referral hospitals] participated in this survey, of which 17 (37.0%) have implemented an institutional guideline. The three most common investigations always conducted following stillbirth are placental histology (20.9%), fetal autopsy (13.1%) and maternal antibody screen (11.5%). Availability of an institutional guideline was not significantly associated with type of hospital, on-site pathology department, or institutional annual live and stillbirth rates. Post-mortem consultations only in cases of abnormal investigations following stillbirth were associated with lower odds for presence of such guideline [OR 0.133 (95% CI 0.018-0.978); p = 0.047]. 26 (56.5%) departments consider a national guideline necessary.
CONCLUSIONS
Less than half of the surveyed maternity units have implemented an institutional guideline on maternal care and investigations following antepartum stillbirth, independent of annual live and stillbirth rate or type of referral centre.
Topics: Austria; Autopsy; Female; Gestational Age; Guidelines as Topic; Health Facilities; Humans; Maternal Age; Maternal Health Services; Placenta; Pregnancy; Risk Factors; Stillbirth; Surveys and Questionnaires
PubMed: 34303351
DOI: 10.1186/s12884-021-03995-z -
American Journal of Obstetrics and... Dec 2005This is a systematic review of the literature on the causes of stillbirth and clinical opinion regarding strategies for its prevention. (Review)
Review
OBJECTIVE
This is a systematic review of the literature on the causes of stillbirth and clinical opinion regarding strategies for its prevention.
STUDY DESIGN
We reviewed the causes of stillbirth by performing a Medline search limited to articles in English published in core clinical journals from January 1, 1995, to January 1, 2005. Articles before this date were included if they added historical information relevant to the topic. A total of 1445 articles obtained, 113 were the basis of this review and chosen based on the criterion that stillbirth or fetal death was central to the article.
RESULTS
Fifteen risk factors for stillbirths were identified and the prevalence of these conditions and associated risks are presented The most prevalent risk factors for stillbirth are prepregnancy obesity, socioeconomic factors, and advanced maternal age. Biologic markers associated with increased stillbirth risk are also reviewed, and strategies for its prevention identified.
CONCLUSION
Identification of risk factors for stillbirth assists the clinician in performing a risk assessment for each patient. Unexplained stillbirths and stillbirths related to growth restriction are the 2 categories of death that contribute the most to late fetal losses. Late pregnancy is associated with an increasing risk of stillbirth, and clinicians should have a low threshold to evaluate fetal growth. The value of antepartum testing is related to the underlying risk of stillbirth and, although the strategy of antepartum testing in patients with increased risk will decrease the risk of late fetal loss, it is of necessity associated with higher intervention rates.
Topics: Abruptio Placentae; Birth Weight; Comorbidity; Female; Fetal Death; Humans; Infertility; Lupus Erythematosus, Systemic; Maternal Age; Obesity; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Pregnancy-Associated Plasma Protein-A; Risk Factors; Stillbirth; Thrombophilia; United States
PubMed: 16325593
DOI: 10.1016/j.ajog.2005.03.074 -
American Journal of Obstetrics and... Feb 1995A history of stillbirth is universally accepted as an indication for antepartum fetal heart rate testing. Our goal was to examine when fetal testing should begin in an...
OBJECTIVE
A history of stillbirth is universally accepted as an indication for antepartum fetal heart rate testing. Our goal was to examine when fetal testing should begin in an otherwise healthy patient with a history of stillbirth.
STUDY DESIGN
This is a nonconcurrent cohort study of patients who were seen for antepartum surveillance from January 1979 to December 1991 with a history of stillbirth as the only indication for testing. Subsequent pregnancies were evaluated for adverse outcomes and abnormal antepartum test results.
RESULTS
There was one case of recurrent stillbirth among the 300 study patients. Nineteen patients (6.4%) had one or more positive antepartum surveillance tests (positive contraction stress test or biophysical profile < or = 4). Three patients (1%) had positive tests before 32 weeks, all of whom were subsequently delivered without incident at term. Three patients were delivered for positive tests at < 36 weeks, one by cesarean section for fetal distress. We could not detect a relationship between the gestational age of the previous stillborn and the incidence of abnormal tests or fetal distress in subsequent pregnancies.
CONCLUSION
Antepartum surveillance should begin at > or = 32 weeks in the healthy pregnant woman with a history of stillbirth.
Topics: Algorithms; Cardiotocography; Cohort Studies; Female; Fetal Death; Fetal Distress; Gestational Age; Humans; Placental Insufficiency; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prenatal Care; Recurrence
PubMed: 7856674
DOI: 10.1016/0002-9378(95)90561-8 -
Journal of Clinical Medicine Dec 2021(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and...
(1) Background: Across Europe, the incidence of antepartum stillbirth varies greatly, partly because of heterogeneous definitions regarding gestational weeks and differences in legislation. With this study, we sought to provide a comprehensive overview on the demographics of antepartum stillbirth in Austria, defined as non-iatrogenic fetal demise ≥22 gestational weeks (/40). (2) Methods: We conducted a population-based study on epidemiological characteristics of singleton antepartum stillbirth in Austria between January 2008 and December 2020. Data were derived from the validated Austrian Birth Registry. (3) Results: From January 2008 through December 2020, the antepartum stillbirth rate ≥20/40 was 3.10, ≥22/40 3.14, and ≥24/40 2.83 per 1000 births in Austria. The highest incidence was recorded in the federal states of Vienna, Styria, and Lower and Upper Austria, contributing to 71.9% of all stillbirths in the country. In the last decade, significant fluctuations in incidence were noted: from 2011 to 2012, the rate significantly declined from 3.40 to 3.07‰, whilst it significantly increased from 2.76 to 3.49‰ between 2019 and 2020. The median gestational age of antepartum stillbirth in Austria was 33 (27-37) weeks. Stillbirth rates ≤26/40 ranged from 164.98 to 334.18‰, whilst the lowest rates of 0.58-8.4‰ were observed ≥36/40. The main demographic risk factors were maternal obesity and low parity. (4) Conclusions: In Austria, the antepartum stillbirth rate has remained relatively stable at 2.83-3.10 per 1000 births for the last decade, despite a significant decline in 2012 and an increase in 2020.
PubMed: 34945123
DOI: 10.3390/jcm10245828