A Population-based Case-Control Study of Stillbirth: The Relationship of Significant Life Events to the Racial Disparity for African Americans

American journal of epidemiology (Impact Factor: 5.23). 03/2013; 177(8). DOI: 10.1093/aje/kws381
Source: PubMed


Stillbirths (fetal deaths occurring at ≥20 weeks' gestation) are approximately equal in number to infant deaths in the United States and are twice as likely among non-Hispanic black births as among non-Hispanic white births. The causes of racial disparity in stillbirth remain poorly understood. A population-based case-control study conducted by the Stillbirth Collaborative Research Network in 5 US catchment areas from March 2006 to September 2008 identified characteristics associated with racial/ethnic disparity and interpersonal and environmental stressors, including a list of 13 significant life events (SLEs). The adjusted odds ratio for stillbirth among women reporting all 4 SLE factors (financial, emotional, traumatic, and partner-related) was 2.22 (95% confidence interval: 1.43, 3.46). This association was robust after additional control for the correlated variables of family income, marital status, and health insurance type. There was no interaction between race/ethnicity and other variables. Effective ameliorative interventions could have a substantial public health impact, since there is at least a 50% increased risk of stillbirth for the approximately 21% of all women and 32% of non-Hispanic black women who experience 3 or more SLE factors during the year prior to delivery.

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    • "Stillbirth has been established as a psychological trauma and is one of the most common adverse pregnancy outcomes in the United States [1]. Defined as fetal death at 20 or more weeks of gestation, stillbirth occurs 100 times per day and in one in every 150 pregnancies, totaling approximately 25,894 per year [2,3]. The labor, birth, and postpartum periods of women who experience stillbirth are physically similar to those of women who give birth to live, healthy babies; however, the negative effects are significantly greater [4]. "
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    ABSTRACT: Research provides strong evidence for improvements in depressive symptoms as a result of physical activity participation in many populations including pregnant and post-partum women. Little is known about how women who have experienced stillbirth (defined as fetal death at 20 or more weeks of gestation) feel about physical activity or use physical activity following this experience. The purpose of this study was to qualitatively explore women's beliefs about physical activity following a stillbirth. This was an exploratory qualitative research study. Participants were English-speaking women between the ages of 19 and 44 years who experienced a stillbirth in the past year from their recruitment date. Interviews were conducted over the phone or in-person based on participants' preferences and location of residence and approximately 30-45 minutes in length. Twenty-four women participated in the study (M age = 33 +/- 3.68 years; M time since stillbirth = 6.33 +/- 3.06 months). Women's beliefs about physical activity after stillbirth were coded into the following major themes: barriers to physical activity (emotional symptoms and lack of motivation, tired, lack of time, guilt, letting go of a pregnant body, and seeing other babies), benefits to physical activity (feeling better emotionally/mentally, helping women to cope or be therapeutic), importance of physical activity (working through grief, time for self), motivators for physical activity (body shape/weight, health, more children, be a role model, already an exerciser). Health care providers and their role in physical activity participation was also a major theme. This is the first study to qualitatively explore beliefs about physical activity in women after a stillbirth. Women who have experienced stillbirth have unique beliefs about physical activity related to their experience with stillbirth. Findings from this study may help to improve the health and quality of life for women who have experienced stillbirth by utilizing physical activity as a strategy for improving depressive symptoms associated with experiencing a stillbirth. Future research in this area is highly warranted.
    BMC Pregnancy and Childbirth 01/2014; 14(1):26. DOI:10.1186/1471-2393-14-26 · 2.19 Impact Factor
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    ABSTRACT: Depression and stress have been linked with poor contraceptive behavior, but whether existing mental health symptoms influence women's subsequent risk of unintended pregnancy is unclear. We prospectively examined the effect of depression and stress symptoms on young women's pregnancy risk over one year. We used panel data from a longitudinal study of 992 U.S. women ages 18–20 years who reported a strong desire to avoid pregnancy. Weekly journal surveys measured relationship, contraceptive use and pregnancy outcomes. We examined 27,572 journal surveys from 940 women over the first study year. Our outcome was self-reported pregnancy. At baseline, we assessed moderate/severe depression (CESD-5) and stress (PSS-4) symptoms. We estimated the effect of baseline mental health symptoms on pregnancy risk with discrete-time, mixed-effects, proportional hazard models using logistic regression. At baseline, 24% and 23% of women reported moderate/severe depression and stress symptoms, respectively. Ten percent of young women not intending pregnancy became pregnant during the study. Rates of pregnancy were higher among women with baseline depression (14% versus 9%, p = 0.04) and stress (15% versus 9%, p = 0.03) compared to women without symptoms. In multivariable models, the risk of pregnancy was 1.6 times higher among women with stress symptoms compared to those without stress (aRR 1.6, CI 1.1,2.7). Women with co-occurring stress and depression symptoms had over twice the risk of pregnancy (aRR 2.1, CI 1.1,3.8) compared to those without symptoms. Among women without a prior pregnancy, having co-occurring stress and depression symptoms was the strongest predictor of subsequent pregnancy (aRR 2.3, CI 1.2,4.3), while stress alone was the strongest predictor among women with a prior pregnancy (aRR 3.0, CI 1.1,8.8). Depression symptoms were not independently associated with young women's pregnancy risk. In conclusion, stress, and especially co-occurring stress and depression symptoms, consistently and adversely influenced these young women's risk of unintended pregnancy over one year.
    Social Science [?] Medicine 02/2014; 100(2):62–71. DOI:10.1016/j.socscimed.2013.10.037 · 2.89 Impact Factor
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    ABSTRACT: Background Data on cultural groups at risk of stillbirth in high-income countries are scarce. We sought to determine disparities in stillbirth by gestational age for Haitian vs. non-Haitian Canadians.Methods We used data on 10 287 stillbirths and 2 482 364 livebirths from 1981–2010 in the province of Quebec, Canada. Stillbirth rates for Haitians were compared with non-Haitians using fetuses at risk denominators, and Cox proportional hazards regression models with gestational age as the time scale.ResultsStillbirth rates were much higher for Haitians than non-Haitians during the study period (7.2 vs. 3.9 per 1000 total births). Disparities between Haitians and non-Haitians were largest at 32–36 weeks of gestation [hazard ratio 2.22, 95% confidence interval 1.61, 3.07].Conclusions Stillbirth rates in Haitian Canadians giving birth in Quebec are exceptionally high. Disparities were greatest during the late preterm period.
    Paediatric and Perinatal Epidemiology 05/2014; 28(4). DOI:10.1111/ppe.12126 · 3.13 Impact Factor
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