Article

Causes of Death Among Stillbirths

Department of Obstetrics and Gynecology, Drexel University, Filadelfia, Pennsylvania, United States
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 12/2011; 306(22):(4):2459-2468. DOI: 10.1097/OGX.0b013e3182502211

ABSTRACT com-mon adverse pregnancy out-comes in the United States and affects approximately 1 in 160 pregnancies. 1 These approximately 26 000 still-births per year are equivalent to the number of infant deaths. 2 The still-birth rate in the United States is higher than that of many other developed countries. 3-5 From 1990-2003, the still-birth rate declined slowly but steadily, by an average of 1.4% per year. In con-trast, the infant mortality rate de-clined twice as fast by an average of 2.8% per year. 1 Since 2003 the still-birth rate in the United States has re-mained stagnant at 6.2 stillbirths per 1000 births, 1 59% higher than the Healthy People 2010 target goal of 4.1 fetal deaths per 1000 births. 6 US stillbirth prevalence shows sig-nificant racial disparity. The stillbirth rate for non-Hispanic black women is 2.3-fold higher than that of non-Hispanic white women (11.13 com-pared with 4.79 fetal deaths per 1000 live births and fetal deaths). 1 The rate for Hispanic women is 14% higher than for non-Hispanic white women (5.44 per 1000 live births and fetal deaths). Much of the racial disparity in still-birth remains unexplained. 7-11 The Stillbirth Collaborative Re-search Network (SCRN) was initiated by the Eunice Kennedy Shriver Na-tional Institute of Child Health and Hu-man Development (NICHD) to ad-dress this major public health issue. A workshop of experts convened by NICHD in 2001 concluded that vital records were inadequate to address the Context Stillbirth affects 1 in 160 pregnancies in the United States, equal to the num-ber of infant deaths each year. Rates are higher than those of other developed coun-tries and have stagnated over the past decade. There is significant racial disparity in the rate of stillbirth that is unexplained.

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    ABSTRACT: T HE NUMBER OF STILLBIRTHS (FE-tal deaths at 20 weeks' ges-tation) is nearly equal to the number of infant deaths in the United States (25 894 vs 28 384 in 2005). 1 Although rates of stillbirth de-creased in the first part of the 20th cen-tury, rates have been relatively stable over the past few decades. 2 Racial/ ethnic disparities have been reported, with stillbirth rates among non-Hispanic blacks being twice those among non-Hispanic whites. 2 Most studies of risk factors for still-birth use vital statistics with limited data. The Stillbirth Collaborative Re-search Network was created to con-duct a detailed, population-based study of stillbirth in selected areas of the United States, with one of the a priori objectives to determine risk factors for stillbirth and reasons for racial dispari-ties. Many of the factors associated with stillbirth need to be addressed early in pregnancy. Although other factors may be important later in pregnancy, clini-cians providing obstetrical care fre-quently spend relatively more time at the initial visits counseling patients re-garding their risk of adverse preg-nancy outcomes. We focused this ini-tial report on factors that could be ascertained at the start of pregnancy to provide the clinician and patient with population-based data applicable to the first prenatal visits. A subsequent re-port will address pregnancy predic-tors of stillbirth risk. METHODS Study Design The overall design and methods of the study have been reported. 3 The study population consisted of residents in 5 geographic catchment areas defined a priori by county lines. Study
    JAMA The Journal of the American Medical Association 12/2011; 306(22)(14):2469-79. DOI:10.1001/jama.2011.1798 · 30.39 Impact Factor
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