Stillbirths: Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020

Okwaraji YB 1 , Suárez-Idueta L 2 , Ohuma EO 1 , Bradley E 1 , Yargawa J 1 , Pingray V 3 Show all authors , Cormick G 3 , Gordon A 4 , Flenady V 4 , Horváth-Puhó E 5 , Sørensen HT 5 , Sakkeus L 6 , Abuladze L 6 , Heidarzadeh M 7 , Khalili N 8 , Yunis KA 9 , Al Bizri A 9 , Karalasingam SD 10 , Jeganathan R 11 , Barranco A 12 , van Dijk AE 13 , Broeders L 13 , Alyafei F 14 , AlQubaisi M 15 , Razaz N 16 , Söderling J 16 , Smith LK 17 , Matthews RJ 17 , Wood R 18 , Monteath K 19 , Pereyra I 20 , Pravia G 21 , Lisonkova S 22 , Wen Q 22 , Lawn JE 1 , Blencowe H 1 , National Vulnerable Newborn Collaborative Group for Stillbirths

Affiliations 

  • 1 Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
  • 2 Mexican Society of Public Health, Mexico City, Mexico
  • 3 Institute for Clinical Effectiveness and Health Policy, Ciudad Autónoma de Buenos Aires, Argentina
  • 4 Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  • 5 Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
  • 6 School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
  • 7 Paediatrics Department, Alzahra Hospital Iran, Tabriz, Iran
  • 8 Department of Community and Family Medicine, Preventive Medicine and Public Health Research Centre, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  • 9 Division of Neonatology, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
  • 10 Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia
  • 11 Department of Obstetrics & Gynaecology, Malaysia Monash Medical School, Johor Bahru, Malaysia
  • 12 Directorate of Health Information, Ministry of Health, Mexico City, Mexico
  • 13 Perined, Utrecht, The Netherlands
  • 14 Department of Paediatrics, Hamad General Hospital, Doha, Qatar
  • 15 NICU, Women Wellness and Research Centre, Doha, Qatar
  • 16 Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
  • 17 Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
  • 18 Public Health Scotland, Edinburgh, UK
  • 19 Pregnancy, Birth and Child Health Team, Public Health Scotland, Edinburgh, UK
  • 20 Faculty of Health Sciences, Catholic University of Maule, Curicó, Chile
  • 21 Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
  • 22 Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
BJOG, 2023 Nov 29.
PMID: 38018284 DOI: 10.1111/1471-0528.17653

Abstract

OBJECTIVE: To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types'.

DESIGN: Population-based multi-country analyses.

SETTING: Births collected through routine data systems in 13 countries.

SAMPLE: 125 419 255 total births from 22+0 to 44+6 weeks' gestation identified from 2000 to 2020.

METHODS: We included 635 107 stillbirths from 22+0  weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37+0  weeks versus term, T, ≥37+0  weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards.

MAIN OUTCOME MEASURES: Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types.

RESULTS: 635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22+0  weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age.

CONCLUSIONS: In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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