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Lancet (London, England) Feb 2016Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature... (Review)
Review
Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.
Topics: Costs and Cost Analysis; Family Health; Female; Financial Support; Grief; Health Care Costs; Health Expenditures; Health Personnel; Humans; Income; Parents; Pregnancy; Prenatal Care; Quality-Adjusted Life Years; Social Security; Social Support; Stereotyping; Stillbirth; Stress, Psychological
PubMed: 26794073
DOI: 10.1016/S0140-6736(15)00836-3 -
Obstetrics and Gynecology Mar 2020Umbilical cord abnormalities are commonly cited as a cause of stillbirth, but details regarding these stillbirths are rare. Our objective was to characterize stillbirths...
OBJECTIVE
Umbilical cord abnormalities are commonly cited as a cause of stillbirth, but details regarding these stillbirths are rare. Our objective was to characterize stillbirths associated with umbilical cord abnormalities using rigorous criteria and to examine associated risk factors.
METHODS
The Stillbirth Collaborative Research Network conducted a case-control study of stillbirth and live births from 2006 to 2008. We analyzed stillbirths that underwent complete fetal and placental evaluations and cause of death analysis using the INCODE (Initial Causes of Fetal Death) classification system. Umbilical cord abnormality was defined as cord entrapment (defined as nuchal, body, shoulder cord accompanied by evidence of cord occlusion on pathologic examination); knots, torsions, or strictures with thrombi, or other obstruction by pathologic examination; cord prolapse; vasa previa; and compromised fetal microcirculation, which is defined as a histopathologic finding that represents objective evidence of vascular obstruction and can be used to indirectly confirm umbilical cord abnormalities when suspected as a cause for stillbirth. We compared demographic and clinical factors between women with stillbirths associated with umbilical cord abnormalities and those associated with other causes, as well as with live births. Secondarily, we analyzed the subset of pregnancies with a low umbilical cord index.
RESULTS
Of 496 stillbirths with complete cause of death analysis by INCODE, 94 (19%, 95% CI 16-23%) were associated with umbilical cord abnormality. Forty-five (48%) had compromised fetal microcirculation, 27 (29%) had cord entrapment, 26 (27%) knots, torsions, or stricture, and five (5%) had cord prolapse. No cases of vasa previa occurred. With few exceptions, maternal characteristics were similar between umbilical cord abnormality stillbirths and non-umbilical cord abnormality stillbirths and between umbilical cord abnormality stillbirths and live births, including among a subanalysis of those with hypo-coiled umbilical cords.
CONCLUSION
Umbilical cord abnormalities are an important risk factor for stillbirth, accounting for 19% of cases, even when using rigorous criteria. Few specific maternal and clinical characteristics were associated with risk.
Topics: Adult; Case-Control Studies; Female; Humans; Pregnancy; Stillbirth; Umbilical Cord; United States; Young Adult
PubMed: 32028503
DOI: 10.1097/AOG.0000000000003676 -
BMJ (Clinical Research Ed.) Nov 2020To assess whether exposure to high temperatures in pregnancy is associated with increased risk for preterm birth, low birth weight, and stillbirth. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess whether exposure to high temperatures in pregnancy is associated with increased risk for preterm birth, low birth weight, and stillbirth.
DESIGN
Systematic review and random effects meta-analysis.
DATA SOURCES
Medline and Web of Science searched up to September 2018, updated in August 2019.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Clinical studies on associations between high environmental temperatures, and preterm birth, birth weight, and stillbirths.
RESULTS
14 880 records and 175 full text articles were screened. 70 studies were included, set in 27 countries, seven of which were countries with low or middle income. In 40 of 47 studies, preterm births were more common at higher than lower temperatures. Exposures were classified as heatwaves, 1°C increments, and temperature threshold cutoff points. In random effects meta-analysis, odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. Higher temperature was associated with reduced birth weight in 18 of 28 studies, with considerable statistical heterogeneity. Eight studies on stillbirths all showed associations between temperature and stillbirth, with stillbirths increasing 1.05-fold (1.01 to 1.08) per 1°C rise in temperature. Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings.
CONCLUSIONS
Although summary effect sizes are relatively small, heat exposures are common and the outcomes are important determinants of population health. Linkages between socioeconomic status and study outcomes suggest that risks might be largest in low and middle income countries. Temperature rises with global warming could have major implications for child health.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD 42019140136 and CRD 42018118113.
Topics: Female; Hot Temperature; Humans; Infant, Low Birth Weight; Infant, Newborn; Pregnancy; Premature Birth; Risk Factors; Stillbirth
PubMed: 33148618
DOI: 10.1136/bmj.m3811 -
International Journal of Epidemiology Feb 2023Coffee consumption has been associated with several adverse pregnancy outcomes, although data from randomized-controlled trials are lacking. We investigate whether there... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Coffee consumption has been associated with several adverse pregnancy outcomes, although data from randomized-controlled trials are lacking. We investigate whether there is a causal relationship between coffee consumption and miscarriage, stillbirth, birthweight, gestational age and pre-term birth using Mendelian randomization (MR).
METHODS
A two-sample MR study was performed using summary results data from a genome-wide association meta-analysis of coffee consumption (N = 91 462) from the Coffee and Caffeine Genetics Consortium. Outcomes included self-reported miscarriage (N = 49 996 cases and 174 109 controls from a large meta-analysis); the number of stillbirths [N = 60 453 from UK Biobank (UKBB)]; gestational age and pre-term birth (N = 43 568 from the 23andMe, Inc cohort) and birthweight (N = 297 356 reporting own birthweight and N = 210 248 reporting offspring's birthweight from UKBB and the Early Growth Genetics Consortium). Additionally, a one-sample genetic risk score (GRS) analysis of coffee consumption in UKBB women (N up to 194 196) and the Avon Longitudinal Study of Parents and Children (N up to 6845 mothers and 4510 children) and its relationship with offspring outcomes was performed.
RESULTS
Both the two-sample MR and one-sample GRS analyses showed no change in risk of sporadic miscarriages, stillbirths, pre-term birth or effect on gestational age connected to coffee consumption. Although both analyses showed an association between increased coffee consumption and higher birthweight, the magnitude of the effect was inconsistent.
CONCLUSION
Our results suggest that coffee consumption during pregnancy might not itself contribute to adverse outcomes such as stillbirth, sporadic miscarriages and pre-term birth or lower gestational age or birthweight of the offspring.
Topics: Pregnancy; Child; Humans; Female; Birth Weight; Stillbirth; Coffee; Abortion, Spontaneous; Gestational Age; Longitudinal Studies; Mendelian Randomization Analysis; Genome-Wide Association Study; Term Birth
PubMed: 35679582
DOI: 10.1093/ije/dyac121 -
Environmental Research Aug 2021Elevated temperature is well-recognized as a health hazard, and may be particularly harmful to pregnant women, including increasing risk of stillbirth. We conducted a...
BACKGROUND
Elevated temperature is well-recognized as a health hazard, and may be particularly harmful to pregnant women, including increasing risk of stillbirth. We conducted a study in Northern and Central Florida, an area prone to periodic extreme heat but with significant seasonal variation, focusing on the most socioeconomically vulnerable populations least able to mitigate the impact of heat.
METHODS
We obtained electronic health records data from the OneFlorida Data Trust for the period 2012-2017, with 1876 stillbirths included in the analysis. We used a case-crossover design to examine the risk of stillbirth associated with acute exposures to elevated heat prior to the outcome, contrasting the case period (the week preceding the stillbirth) with a control period (the week prior to the case period and the week after the stillbirth). Average heat index and maximum warning level during the case and control periods of each woman were assigned by ZIP code. Conditional logistic regression models were used to assess the association between stillbirth and heat exposure, controlling for PM and O.
RESULTS
The adjusted odds ratio showed no overall association with stillbirth except for a weak association for exposure above the 90th percentile which was larger among the most socioeconomically deprived and non-Hispanic Black women. In the hot months, there was a clear association for all indices of heat exposure, but largest again for the most socioeconomically deprived population (aOR = 2.4, 95% CI: 1.2-5.2 in the 4th vs. 1st quartile) and among non-Hispanic Black women (aOR = 1.8, 95% CI: 1.0-3.2 in the 4th vs. 1st quartile).
CONCLUSIONS
Our results provide further evidence that elevated ambient heat is related to stillbirth and encourage a focus on the most susceptible individuals and possible clinical pathways.
Topics: Cross-Over Studies; Female; Florida; Hot Temperature; Humans; Odds Ratio; Pregnancy; Risk Factors; Stillbirth
PubMed: 33974845
DOI: 10.1016/j.envres.2021.111262 -
Reviews on Environmental Health Sep 2018The developing fetus is particularly susceptible to environmental pollutants, and evidence has shown adverse effects of air pollutants on pregnancy and birth outcomes.... (Review)
Review
The developing fetus is particularly susceptible to environmental pollutants, and evidence has shown adverse effects of air pollutants on pregnancy and birth outcomes. Pregnancy loss, including spontaneous abortion (miscarriage) and stillbirth, is the most severe adverse pregnancy outcome. This review focuses on air pollution exposure during pregnancy in relation to spontaneous abortion and stillbirth. A total of 43 studies are included in this review, including 35 human studies and eight animal studies. Overall, these studies suggest that exposure to air pollutants such as particulate matter (PM), carbon monoxide (CO) and cooking smoke may be associated with higher risk for stillbirth and spontaneous abortion. PM exposure during an entire pregnancy was associated with increased risk of spontaneous abortion, and exposure to PM and PM in the third trimester might increase the risk of stillbirth. CO exposure during the first trimester of pregnancy was associated with an increased risk of spontaneous abortion and exposure during the third trimester was associated with an increased risk of stillbirth. Cooking smoke was found to increase the risk of stillbirths, and the evidence was consistent. Insufficient and conflicting evidence was found for various other pollutants, such as NO and SO. Studies did not show clear evidence for associations between pregnancy loss and others pollutants such as heavy metals, organochlorine compounds, PAH and total dust count. Further research is warranted to better understand the relationship between air pollution exposure and pregnancy loss.
Topics: Abortion, Spontaneous; Air Pollution; Female; Humans; Incidence; Pregnancy; Stillbirth
PubMed: 29975668
DOI: 10.1515/reveh-2017-0033 -
Bioethics Jul 2015Estimates of the burden of disease assess the mortality and morbidity that affect a population by producing summary measures of health such as quality-adjusted life...
Estimates of the burden of disease assess the mortality and morbidity that affect a population by producing summary measures of health such as quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). These measures typically do not include stillbirths (fetal deaths occurring during the later stages of pregnancy or during labor) among the negative health outcomes they count. Priority-setting decisions that rely on these measures are therefore likely to place little value on preventing the more than three million stillbirths that occur annually worldwide. In contrast, neonatal deaths, which occur in comparable numbers, have a substantial impact on burden of disease estimates and are commonly seen as a pressing health concern. In this article we argue in favor of incorporating unintended fetal deaths that occur late in pregnancy into estimates of the burden of disease. Our argument is based on the similarity between late-term fetuses and newborn infants and the assumption that protecting newborns is important. We respond to four objections to counting stillbirths: (1) that fetuses are not yet part of the population and so their deaths should not be included in measures of population health; (2) that valuing the prevention of stillbirths will undermine women's reproductive rights; (3) that including stillbirths implies that miscarriages (fetal deaths early in pregnancy) should also be included; and (4) that birth itself is in fact ethically significant. We conclude that our proposal is ethically preferable to current practice and, if adopted, is likely to lead to improved decisions about health spending.
Topics: Abortion, Induced; Abortion, Spontaneous; Cost of Illness; Female; Fetal Death; Fetal Mortality; Global Health; Humans; Infant; Infant Mortality; Infant, Newborn; Parturition; Pregnancy; Quality-Adjusted Life Years; Stillbirth
PubMed: 25395144
DOI: 10.1111/bioe.12120 -
Environmental Health : a Global Access... Jun 2022Heatwaves are becoming more frequent and may acutely increase the risk of stillbirth, a rare and severe pregnancy outcome. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Heatwaves are becoming more frequent and may acutely increase the risk of stillbirth, a rare and severe pregnancy outcome.
OBJECTIVES
Examine the association between multiple heatwave metrics and stillbirth in six U.S. states.
METHODS
Data were collected from fetal death and birth records in California (1996-2017), Florida (1991-2017), Georgia (1994-2017), Kansas (1991-2017), New Jersey (1991-2015), and Oregon (1991-2017). Cases were matched to controls 1:4 based on maternal race/ethnicity, maternal education, and county, and exposure windows were aligned (gestational week prior to stillbirth). County-level temperature data were obtained from Daymet and linked to cases and controls by residential county and the exposure window. Five heatwave metrics (1 categorical, 3 dichotomous, 1 continuous) were created using different combinations of the duration and intensity of hot days (mean daily temperature exceeding the county-specific 97.5 percentile) during the exposure window, as well as a continuous measure of mean temperature during the exposure window modeled using natural splines to allow for nonlinear associations. State-specific odds ratios (ORs) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. State-specific results were pooled using a fixed-effects meta-analysis.
RESULTS
In our data set of 140,428 stillbirths (553,928 live birth controls), three of the five heatwave metrics examined were not associated with stillbirth. However, four consecutive hot days during the previous week was associated with a 3% increase in stillbirth risk (CI: 1.01, 1.06), and a 1 °C average increase over the threshold was associated with a 10% increase in stillbirth risk (CI: 1.04, 1.17). In continuous temperature analyses, there was a slight increased risk of stillbirth associated with extremely hot temperatures (≥ 35 °C).
DISCUSSION
Most heat wave definitions examined were not associated with acute changes in stillbirth risk; however, the most extreme heatwave durations and temperatures were associated with a modest increase in stillbirth risk.
Topics: Female; Hot Temperature; Humans; Odds Ratio; Pregnancy; Risk Factors; Stillbirth; Temperature
PubMed: 35710419
DOI: 10.1186/s12940-022-00870-y -
Bulletin of the World Health... Mar 2023To assess the extent of under-reporting of stillbirths in India by comparing stillbirth and neonatal mortality rates from two national data sources and to review... (Review)
Review
OBJECTIVE
To assess the extent of under-reporting of stillbirths in India by comparing stillbirth and neonatal mortality rates from two national data sources and to review possible reasons for undercounting of stillbirths.
METHODS
We extracted data on stillbirth and neonatal mortality rates from the annual reports for 2016-2020 of the sample registration system, the Indian government's main source of vital statistics. We compared the data with estimates of stillbirth and neonatal mortality rates from the fifth round of the Indian national family health survey covering events from 2016-2021. We reviewed the questionnaires and manuals from both surveys and compared the sample registration system's verbal autopsy tool with other international tools.
FINDINGS
The stillbirth rate for India from the national family health survey (9.7 stillbirths per 1000 births; 95% confidence interval: 9.2-10.1) was 2.6 times higher than the average rate reported in the sample registration system over 2016-2020 (3.8 stillbirths per 1000 births). However, neonatal mortality rates in the two data sources were similar. We identified issues with the definition of stillbirth, documentation of gestation period, and categorization of miscarriages and abortions that could result in undercounting stillbirths in the sample registration system. In the national family health survey only one adverse pregnancy outcome is documented, irrespective of the number of adverse pregnancy outcomes in the given period.
CONCLUSION
For India to attain its 2030 target of single-digit stillbirth rate and to monitor actions to end preventable stillbirths, efforts are needed to improve the documentation of stillbirths in its data collection systems.
Topics: Female; Infant, Newborn; Humans; Pregnancy; Stillbirth; Infant Mortality; Parturition; India; Health Surveys
PubMed: 36865608
DOI: 10.2471/BLT.22.288906 -
Environment International Oct 2019Pregnant women may be vulnerable to changes in ambient temperature and warming climates. Recent evidence suggests that temperature increases are associated with...
BACKGROUND
Pregnant women may be vulnerable to changes in ambient temperature and warming climates. Recent evidence suggests that temperature increases are associated with placental abruption, a risk factor for stillbirth.
OBJECTIVES
We investigated the effect of acute exposures to apparent temperature on stillbirths in Harris County, Texas, 2008-2013.
METHODS
We conducted a case-crossover study to investigate the association between temperature and stillbirth among 708 women. We used data from the National Climatic Data Center to estimate maternal exposure to daily average apparent temperature over the days (lag days 1 through 6) preceding the stillbirth event. We employed symmetric bidirectional sampling to select six control periods one to three weeks before and after each event and applied conditional logistic regression to examine associations between increases of apparent temperature and stillbirths during the warm season (May-September). We adjusted for fine particulate matter (PM), nitrogen dioxide (NO) and ozone (O) and used stratified analysis to examine differences in risk by maternal race/ethnicity. We also examined the association among stillbirths with and without placental abruptions.
RESULTS
Independent of air pollutant exposures, a 10 °F increase in apparent temperature in the week preceding delivery (lag days 1 to 6) was positively associated with a 45% (adjusted OR = 1.45, 95% confidence interval (CI): 1.18, 1.77) increase in risk for stillbirth. Risks were elevated for stillbirths occurring in June through August, for Hispanic and non-Hispanic Black women, but not for non-Hispanic Whites. We also observed elevated risks associated with temperature increases in the few days preceding delivery among stillbirths caused by placental abruption, with the risk being highest on lag day 1 (OR = 1.93, 95% CI: 1.15, 3.23).
CONCLUSIONS
Independent of maternal ambient air pollutant exposure, we found evidence of an association between apparent temperature increases in the week preceding an event and risk of stillbirth. Risks for stillbirth varied by race/ethnicity. Further, in the first study to evaluate the impact of temperature on a specific complication during pregnancy, the risks were higher among mothers with placental abruption.
Topics: Abruptio Placentae; Adult; Air Pollution; Cross-Over Studies; Female; Humans; Nitrogen Dioxide; Particulate Matter; Pregnancy; Risk Factors; Stillbirth; Temperature; Texas; Weather; Young Adult
PubMed: 31376592
DOI: 10.1016/j.envint.2019.105067