Abstract
ObjectiveTo develop a model for prediction of stillbirth after the 28th gestational week in singleton pregnancies of women with overweight or obesity.MethodThis is a register-based cohort study. The first trimester screening database including data from 2006 until 2015 was cross-linked with the Swedish Medical Birth Register and the Swedish Register of Total Population. The final study cohort comprised 145,319 pregnancies, out of which 45,859 pregnancies were complicated by overweight or obesity and without pre-gestational diabetes. There were in total 282 stillbirths. Prediction models for stillbirth in pregnancies with overweight or obesity were constructed based on maternal characteristics, pregnancy complications and biochemical markers. Receiver Operating Characteristic (ROC) and area under curve (AUC) were calculated, based on logistic regression analyses.ResultsThe prevalence of stillbirth was 1.6/1000 births and 2.6/1000 births in normal weight and overweight/obese women, respectively. The final predictive model had an AUC of 0.69 (95% CI: 0.64–0.74) with a sensitivity of 28% at a 90% fixed specificity.ConclusionsIt is possible to predict 28% of stillbirths in overweight or obese women, at a false positive rate of 10%. In particular, growth-restricted fetuses are at increased risk of stillbirth.
Highlights
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Stillbirth is most prevalent in low-resource regions of the world, but is a public health problem in high-resource regions [1, 2] where stillbirth from the 22nd gestational week accounts for the majority of all perinatal deaths [1]
We hypothesized that a substantial proportion of stillbirths in pregnancies with overweight/obesity could be predicted based on maternal characteristics, maternal first-trimester serum levels of pregnancy associated plasma protein A (PAPP-A) and early fetal growth
Summary
The first trimester screening database including data from 2006 until 2015 was cross-linked with the Swedish Medical Birth Register and the Swedish Register of Total Population. The final study cohort comprised 145,319 pregnancies, out of which 45,859 pregnancies were complicated by overweight or obesity and without pre-gestational diabetes. Prediction models for stillbirth in pregnancies with overweight or obesity were constructed based on maternal characteristics, pregnancy complications and biochemical markers. Receiver Operating Characteristic (ROC) and area under curve (AUC) were calculated, based on logistic regression analyses
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