Article

Major Risk Factors for Stillbirth in High-Income Countries: A Systematic Review and Meta-Analysis EDITORIAL COMMENT

University of Adelaide, Tarndarnya, South Australia, Australia
The Lancet (Impact Factor: 45.22). 04/2011; 377(9774):1331-40. DOI: 10.1016/S0140-6736(10)62233-7
Source: PubMed

ABSTRACT

Stillbirth rates in high-income countries have shown little or no improvement over the past two decades. Prevention strategies that target risk factors could be important in rate reduction. This systematic review and meta-analysis was done to identify priority areas for stillbirth prevention relevant to those countries.
Population-based studies addressing risk factors for stillbirth were identified through database searches. The factors most frequently reported were identified and selected according to whether they could potentially be reduced through lifestyle or medical intervention. The numbers attributable to modifiable risk factors were calculated from data relating to the five high-income countries with the highest numbers of stillbirths and where all the data required for analysis were available. Odds ratios were calculated for selected risk factors, from which population-attributable risk (PAR) values were calculated.
Of 6963 studies initially identified, 96 population-based studies were included. Maternal overweight and obesity (body-mass index >25 kg/m(2)) was the highest ranking modifiable risk factor, with PARs of 8-18% across the five countries and contributing to around 8000 stillbirths (≥22 weeks' gestation) annually across all high-income countries. Advanced maternal age (>35 years) and maternal smoking yielded PARs of 7-11% and 4-7%, respectively, and each year contribute to more than 4200 and 2800 stillbirths, respectively, across all high-income countries. In disadvantaged populations maternal smoking could contribute to 20% of stillbirths. Primiparity contributes to around 15% of stillbirths. Of the pregnancy disorders, small size for gestational age and abruption are the highest PARs (23% and 15%, respectively), which highlights the notable role of placental pathology in stillbirth. Pre-existing diabetes and hypertension remain important contributors to stillbirth in such countries.
The raising of awareness and implementation of effective interventions for modifiable risk factors, such as overweight, obesity, maternal age, and smoking, are priorities for stillbirth prevention in high-income countries.
The Stillbirth Foundation Australia, the Department of Health and Ageing, Canberra, Australia, and the Mater Foundation, Brisbane, Australia.

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    • "Obesity and overweight during pregnancy are well-recognized independent risk factors that contribute to the development of metabolic syndrome and several diet-related anomalies not only in the mother, but also in the fetus through fetal programming [American College of Obstetricians and Gynecologists (ACOG), 2005; Flenady et al., 2011; Triunfo and Lanzone, 2014]. This intrauterine programming can be observed as altered responses to physiological stimuli in HUVEC isolated from pathological pregnancies (Cheng et al., 2013; Krause et al., 2013). "

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    • "The review also found that infants born into these circumstances were around twice as likely to be stillborn. Further evidence shows an association between socially disadvantaged pregnant women, low-birth weight, preterm birth and stillbirth (Goldenberg et al., 2008; Blumenshine et al., 2010; Flenady et al., 2011). Research has also shown that in high-income countries, women from socially disadvantaged groups are at greatest risk of the poor outcomes associated with increased obstetric intervention such as induction of labour, epidural anaesthesia, instrumental childbirth and caesarean section (D'Souza and Garcia, 2004; Lawn et al., 2009; Oakley et al., 2009). "
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