학술논문
Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta-analysis.
Document Type
Academic Journal
Author
Thompson RA; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Thompson JMD; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Wilson J; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Cronin RS; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Women's Health Division, Counties Manukau Health, Auckland, New Zealand.; Mitchell EA; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Raynes-Greenow CH; Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.; Li M; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Women's Health Division, Counties Manukau Health, Auckland, New Zealand.; Stacey T; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.; Heazell AEP; University of Manchester, Manchester, UK.; University of Michigan, Ann Arbor, Michigan, USA.; O'Brien LM; University of Michigan, Ann Arbor, Michigan, USA.; McCowan LME; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.; Anderson NH; Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.
Source
Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100935741 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-0528 (Electronic) Linking ISSN: 14700328 NLM ISO Abbreviation: BJOG Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model.
Design: Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors.
Setting: An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study.
Population: Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257).
Methods: Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables.
Main Outcome Measures: Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth.
Results: After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86).
Conclusions: Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.
(© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
Design: Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors.
Setting: An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study.
Population: Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257).
Methods: Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables.
Main Outcome Measures: Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth.
Results: After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86).
Conclusions: Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.
(© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)