Abstract
BackgroundApproximately 5 in 1,000 deliveries in England and Wales result in stillbirth, with little improvement in figures over the last few decades. The aim of this study was to investigate the association between clinical and socio-demographic factors and stillbirth, with a particular focus on ethnicity and obesity.MethodsAnalysis of routine maternity data on 53,293 singleton births occurring in a large London teaching hospital between 2004 and 2012. Logistic regression was used to investigate risk factors for stillbirth and to explore potential effect modification.Results53,293 deliveries occurred during the time period, of which 329 resulted in a stillbirth (6.2 per 1,000 births). Compared to White women, non-White ethnicity was associated with a doubling of the odds of stillbirth (aOR for Black women 2.15, 95% CI 1.56-2.97; aOR for South Asian women 2.33, 95% CI 1.42-3.83). Obese women had a trend towards higher odds of stillbirth compared to women of recommended BMI (aOR 1.38, 95% CI 0.98-1.96), though this was not significant (p 0.07). Both higher parity (≥2 compared to para 1) and hypertension were associated with a higher odds of stillbirth (parity ≥2 aOR 1.65, 95% CI 1.13-2.39; hypertension aOR 1.84, 95% CI 1.22-2.78) but there was no evidence that area deprivation or maternal age were independently associated with stillbirth in this population. There was some evidence of effect modification between ethnicity and obesity (p value for interaction 0.06), with obesity a particularly strong risk factor for stillbirth in South Asian women (aOR 4.64, 95% CI 1.84-11.70).ConclusionsThere was a high prevalence of stillbirth in this multi-ethnic urban population. The increased risk of stillbirth observed in non-White women remains after adjusting for other factors. Our finding of possible effect modification between ethnicity and obesity suggests that further research should be conducted in order to improve understanding of the interplay between ethnicity, obesity and stillbirth.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0404-0) contains supplementary material, which is available to authorized users.
Highlights
5 in 1,000 deliveries in England and Wales result in stillbirth, with little improvement in figures over the last few decades
Little is known about the role of obesity in explaining the higher risk of stillbirth observed in Black and South Asian women in the UK, there is evidence from other high income countries that the association between obesity and obstetric outcomes varies by ethnicity [14,15]
The prevalence of stillbirth was higher in all non-White groups compared to White women: 9.1 per 1,000 for both South Asian and Black women, 6.9 for other ethnic groups, and 3.8 for White women (Additional file 2: Table S2)
Summary
5 in 1,000 deliveries in England and Wales result in stillbirth, with little improvement in figures over the last few decades. Little is known about the role of obesity in explaining the higher risk of stillbirth observed in Black and South Asian women in the UK, there is evidence from other high income countries that the association between obesity and obstetric outcomes varies by ethnicity [14,15]. These studies, predominately conducted in the US, may not be generalizable to the UK due to differences in the composition of ethnic groups between the two countries
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