Abstract
Objective:
To identify maternal characteristics independently associated with pregnancies resulting in intrauterine fetal demise (IUFD).
Study design:
This was a population-based cohort study of all births taking place at the McGill University Health Centre in Montreal, Canada, between 2001 and 2007, using the McGill University Obstetrics and Neonatal Database. Maternal characteristics were compared between pregnancies that resulted in IUFD and control pregnancies resulting in live newborns. A logistic regression analysis was constructed to identify parameters independently associated with IUFD.
Results:
We identified 20,744 births during the study period, 87 of which were complicated by IUFD. Mothers with IUFD were more likely to be younger, with less formal education, higher rates of smoking during pregnancy, and more fetal anomalies (42.5% vs. 7.5%, P<0.001). After exclusion of pregnancies with congenital and/or chromosomal abnormalities, less formal education (7 vs. 13.6 school years, P<0.001) and smoking during pregnancy (24% vs. 7.7%, P<0.001) remained significantly more common in pregnancies resulting in IUFD. In the multivariable regression analysis both smoking and number of maternal school years were independently associated with IUFD pregnancies (OR 2.22 for smoking, P=0.007 and OR 0.865 for number of school years, P<0.001).
Conclusion:
Lower levels of education and smoking during pregnancy are independent predictors of IUFD.
Acknowledgments
We are grateful to Ms. Ronit Leiba for her assistance in the statistical analysis.
Disclosure of interests: All authors declare that no authors (nor their institutions) received payments for their efforts on this project. The authors report no conflict of interest.
Contribution to authorship: AS conceived the study, led the design and plans for analysis, drafted the manuscript, and is the guarantor for the study. All co-authors (AW, RB, AM, MH, AS) contributed to the design, analysis plan, and editing of the manuscript. All authors approved the final version of the submitted manuscript.
Details of ethics approval: The study was approved by the institutional review board of McGill University Health Center (reference number: 12-438-SDR) April 2013.
Funding: This study was not funded.
References
[1] www.stillbirthalliance.org. Accessed on February 28, 2007.Suche in Google Scholar
[2] Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet. 2011;377:1319–30.10.1016/S0140-6736(10)62310-0Suche in Google Scholar
[3] Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: where? When? Why? How to make the data count? Lancet. 2011;377:1448–63.10.1016/S0140-6736(10)62187-3Suche in Google Scholar
[4] Incerpi MH, Miller DA, Samadi R, Settlage RH, Goodwin TM. Stillbirth evaluation: what tests are needed? Am J Obstet Gynecol. 1998;178:1121–5.10.1016/S0002-9378(98)70311-4Suche in Google Scholar
[5] Eller AG, Branch DW, Byrne JL. Stillbirth at term. Obstet Gynecol. 2006;108:442–7.10.1097/01.AOG.0000228857.02137.bdSuche in Google Scholar PubMed
[6] Pathak S, Lees CC, Hackett G, Jessop F, Sebire NJ. Frequency and clinical significance of placental histological lesions in an unselected population at or near term. Virchows Arch. 2011;459:565–72.10.1007/s00428-011-1157-zSuche in Google Scholar PubMed
[7] Pinar H, Goldenberg RL, Koch MA, Heim-Hall J, Hawkins HK, Shehata B, et al. Placental findings in singleton stillbirths. Obstet Gynecol. 2014;123:325–36.10.1097/AOG.0000000000000100Suche in Google Scholar PubMed PubMed Central
[8] American College of Obstetricians and Gynecologists. Genetic evaluation of stillbirths and neonatal deaths. ACOG Committee Opinion No 257. Washington, DC: American College of Obstetricians and Gynecologists; 2001.Suche in Google Scholar
[9] Conde-Agudelo A, Bird S, Kennedy SH, Villar J, Papageorghiou AT. First- and second-trimester tests to predict stillbirth in unselected pregnant women: a systematic review and meta-analysis. BJOG. 2015;122:41–55.10.1111/1471-0528.13096Suche in Google Scholar PubMed
[10] Ohana O, Holcberg G, Sergienko R, Sheiner E. Risk factors for intrauterine fetal death (1988–2009). J Matern Fetal Neonatal Med. 2011;24:1079–83.10.3109/14767058.2010.545918Suche in Google Scholar PubMed
[11] Balchin I, Whittaker JC, Patel RR, Lamont RF, Steer PJ. Racial variation in the association between gestational age and perinatal mortality: prospective study. BMJ. 2007;334:833.10.1136/bmj.39132.482025.80Suche in Google Scholar PubMed PubMed Central
[12] McClure EM, Nalubamba-Phiri M, Goldenberg RL. Stillbirth in developing countries. Int J Gynaecol Obstet. 2006;94:82–90.10.1016/j.ijgo.2006.03.023Suche in Google Scholar PubMed
[13] McClure EM, Wright LL, Goldenberg RL, Goudar SS, Parida SN, Jehan I. The global network: a prospective study of stillbirths in developing countries. Am J Obstet Gynecol. 2007;197:247.e1–5.10.1016/j.ajog.2007.07.004Suche in Google Scholar
[14] Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts RC. Determinants of unexplained antepartum fetal deaths. Obstet Gynecol. 2000;95:215–21.Suche in Google Scholar
[15] Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG. 2014;121(Suppl 4):141–53.10.1111/1471-0528.12995Suche in Google Scholar
[16] Bel-Ange A, Harlev A, Weintraub AY, Sheiner E. Waiting for post-term in healthy women, is it an accident waiting to happen? J Matern Fetal Neonatal Med. 2013;26:779–82.10.3109/14767058.2012.759207Suche in Google Scholar
[17] Liran D, Vardi IS, Sergienko R, Sheiner E. Adverse perinatal outcome in teenage pregnancies: is it all due to lack of prenatal care and ethnicity? J Matern Fetal Neonatal Med. 2013;26:469–72.10.3109/14767058.2012.738262Suche in Google Scholar
[18] Di Mario S, Say L, Lincetto O. Risk factors for stillbirth in developing countries: a systematic review of the literature. Sex Transm Dis. 2007;34:S11–21.10.1097/01.olq.0000258130.07476.e3Suche in Google Scholar
[19] Gibbs RS. The origins of stillbirth: infectious diseases. Semin Perinatol. 2002;26:75–8.10.1053/sper.2002.29839Suche in Google Scholar
[20] Blackwell S, Romero R, Chaiworapongsa T, Refuerzo J, Gervasi MT, Yoshimatsu J, et al. Unexplained fetal death is associated with changes in the adaptive limb of the maternal immune response consistent with prior antigenic exposure. J Matern Fetal Neonatal Med. 2003;14:241–6.10.1080/jmf.14.4.241.246Suche in Google Scholar
[21] Blackwell S, Romero R, Chaiworapongsa T, Kim YM, Bujold E, Espinoza J, et al. Maternal and fetal inflammatory responses in unexplained fetal death. J Matern Fetal Neonatal Med. 2003;14:151–7.10.1080/jmf.14.3.151.157Suche in Google Scholar
[22] Lahra MM, Gordon A, Jeffery HE. Chorioamnionitis and fetal response in stillbirth. Am J Obstet Gynecol. 2007;196:229.e1–4.10.1016/j.ajog.2006.10.900Suche in Google Scholar
[23] Morrison I, Olsen J. Weight-specific stillbirths and associated causes of death: an analysis of 765 stillbirths. Am J Obstet Gynecol. 1985;152:975–80.10.1016/0002-9378(85)90542-3Suche in Google Scholar
[24] Strom CM, Ginsberg N, Applebaum M, Bozorgi N, White M, Caffarelli M, et al. Analyses of 95 first-trimester spontaneous abortions by chorionic villus sampling and karyotype. J Assist Reprod Genet. 1992;9:458–61.10.1007/BF01204052Suche in Google Scholar PubMed
[25] Mei-Dan E, Walfisch A, Weisz B, Hallak M, Brown R, Shrim A. The unborn smoker: association between smoking during pregnancy and adverse perinatal outcomes. J Perinat Med. 2015;43:553–8.10.1515/jpm-2014-0299Suche in Google Scholar PubMed
[26] Burton GJ, Palmer ME, Dalton KJ. Morphometric differences between the placental vasculature of non-smokers, smokers and ex-smokers. Br J Obstet Gynaecol. 1989;96:907–15.10.1111/j.1471-0528.1989.tb03344.xSuche in Google Scholar PubMed
[27] Larsen LG, Clausen HV, Jønsson L. Stereologic examination of placentas from mothers who smoke during pregnancy. Am J Obstet Gynecol. 2002;186:531–7.10.1067/mob.2002.120481Suche in Google Scholar PubMed
[28] Bush PG, Mayhew TM, Abramovich DR, Aggett PJ, Burke MD, Page KR. A quantitative study on the effects of maternal smoking on placental morphology and cadmium concentration. Placenta. 2000;21:247–56.10.1053/plac.1999.0470Suche in Google Scholar PubMed
[29] Lehtovirta P, Forss M. The acute effect of smoking on intervillous blood flow of the placenta. Br J Obstet Gynaecol. 1978;85:729–31.10.1111/j.1471-0528.1978.tb15592.xSuche in Google Scholar PubMed
[30] de la Chica RA, Ribas I, Giraldo J, Egozcue J, Fuster C. Chromosomal instability in amniocytes from fetuses of mothers who smoke. J Am Med Assoc. 2005;293:1212–22.10.1001/jama.293.10.1212Suche in Google Scholar PubMed
[31] Tuthill DP, Stewart JH, Coles EC, Andrews J, Cartlidge PH. Maternal cigarette smoking and pregnancy outcome. Paediatr Perinat Epidemiol. 1999;13:245–53.10.1046/j.1365-3016.1999.00187.xSuche in Google Scholar PubMed
[32] Angell RR, Sandison A, Bain AD. Chromosome variation in perinatal mortality: a survey of 500 cases. J Med Genet. 1984;21:39–44.10.1136/jmg.21.1.39Suche in Google Scholar PubMed PubMed Central
[33] Fretts RC, Boyd ME, Usher RH, Usher HA. The changing pattern of fetal death, 1961–1988. Obstet Gynecol. 1992;79:35–9.Suche in Google Scholar
[34] Windsor RA, Lowe JB, Perkins LL, Smith-Yoder D, Artz L, Crawford M, et al. Health education for pregnant smokers: its behavioral impact and cost benefit. Am J Public Health. 1993;83:201–6.10.2105/AJPH.83.2.201Suche in Google Scholar
[35] U.S. Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:551–5.10.7326/0003-4819-150-8-200904210-00009Suche in Google Scholar PubMed
[36] Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2009; CD001055.10.1002/14651858.CD001055.pub3Suche in Google Scholar PubMed PubMed Central
[37] Melvin CL, Dolan-Mullen P, Windsor RA, Whiteside HP Jr, Goldenberg RL. Recommended cessation counselling for pregnant women who smoke: a review of the evidence. Tob Control. 2000;9(Suppl 3):III80–4.10.1136/tc.9.suppl_3.iii80Suche in Google Scholar PubMed PubMed Central
[38] Pariente G, Shoham-Vardi I, Kessous R, Sergienko R, Sheiner E. Is stillbirth associated with long-term atherosclerotic morbidity? Am J Obstet Gynecol. 2014;211:416.e1–12.10.1016/j.ajog.2014.07.032Suche in Google Scholar PubMed
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2016 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorials
- Editorial
- First 10 years of the International Academy of Perinatal Medicine – which lessons we have learned and what are future challenges
- Recommendation and Guidelines for Perinatal Practice
- Is intrauterine surgery justified? Report from the working group on ultrasound in obstetrics of the World Association of Perinatal Medicine (WAPM)
- Original articles - Obstetrics
- Examiner’s finger-mounted fetal tissue oximetry: a preliminary report on 30 cases
- Values of T/QRS ratio in pregnancies complicated by intrauterine growth restriction
- Cesarean delivery among women with prolonged labor induction
- Maternal and fetal outcomes after uterine fundal pressure in spontaneous and assisted vaginal deliveries
- Impact of maternal age on delivery outcomes following spontaneous labour at term
- Maternal characteristics of pregnancies with intrauterine fetal demise
- Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability
- Perinatal outcomes with isolated oligohydramnios at term pregnancy
- Factors associated with choice of delivery with or without epidural analgesia among laboring women: a cross-sectional survey at a tertiary care hospital of a developing country
- Ultrasonographic assessment of cervical length in pregnancies scheduled for a cesarean delivery: prediction of early spontaneous onset of labor
- Characterization of visceral and subcutaneous adipose tissue transcriptome in pregnant women with and without spontaneous labor at term: implication of alternative splicing in the metabolic adaptations of adipose tissue to parturition
- Classification of stillbirths is an ongoing dilemma
- Out-of-hospital births in the United States 2009–2014
- Congress Calendar
- Congress Calendar
Artikel in diesem Heft
- Frontmatter
- Editorials
- Editorial
- First 10 years of the International Academy of Perinatal Medicine – which lessons we have learned and what are future challenges
- Recommendation and Guidelines for Perinatal Practice
- Is intrauterine surgery justified? Report from the working group on ultrasound in obstetrics of the World Association of Perinatal Medicine (WAPM)
- Original articles - Obstetrics
- Examiner’s finger-mounted fetal tissue oximetry: a preliminary report on 30 cases
- Values of T/QRS ratio in pregnancies complicated by intrauterine growth restriction
- Cesarean delivery among women with prolonged labor induction
- Maternal and fetal outcomes after uterine fundal pressure in spontaneous and assisted vaginal deliveries
- Impact of maternal age on delivery outcomes following spontaneous labour at term
- Maternal characteristics of pregnancies with intrauterine fetal demise
- Evaluation of standardized, computerized Dawes/Redman heart-rate analysis based on different recording methods and in relation to fetal beat-to-beat heart rate variability
- Perinatal outcomes with isolated oligohydramnios at term pregnancy
- Factors associated with choice of delivery with or without epidural analgesia among laboring women: a cross-sectional survey at a tertiary care hospital of a developing country
- Ultrasonographic assessment of cervical length in pregnancies scheduled for a cesarean delivery: prediction of early spontaneous onset of labor
- Characterization of visceral and subcutaneous adipose tissue transcriptome in pregnant women with and without spontaneous labor at term: implication of alternative splicing in the metabolic adaptations of adipose tissue to parturition
- Classification of stillbirths is an ongoing dilemma
- Out-of-hospital births in the United States 2009–2014
- Congress Calendar
- Congress Calendar