Stillbirth complicates 1 in 160 deliveries in the United States. ACOG suggests initiation of antenatal fetal surveillance (ANFS) in most “at risk” women beginning at 32 weeks’ gestation. We sought to quantify the distribution of stillbirths by gestational age (GA) in a contemporary cohort and to determine identifiable risk factors associated with early (<32 weeks) stillbirth. Population-based retrospective cohort study of all stillbirths in the US during the year 2014. Distribution of stillbirths were stratified by GA, 20-44 wks, in women diagnosed with stillbirth in the antepartum period (non- laboring). Maternal, obstetric, and fetal characteristics were compared between those diagnosed with early (< 32 wks) vs late (≥32 wks) occurrence of stillbirth. Multivariate logistic regression estimated the relative influence of various maternal, obstetric, and fetal factors on the outcome of early stillbirth. There were 15,998 non-laboring women diagnosed with stillbirth during 2014 in the U.S. between GA 20-44 weeks. Of those, 60.1% (n=9,618) occurred before ANFS is typically initiated (< 32 wks) and 39.9% (n=6,380) were diagnosed ≥ 32 wks. Median GA at diagnosis was 23 (IQR 21,27) vs 37 (IQR (34,39) wks between GA cohort groups. Women with early stillbirth were more likely to be of Non-Hispanic Black race (29.0 vs 23.9%, p<0.001), to be primiparous (53.8 vs 50.6%, p=0.001), have chronic HTN (6.0 vs 4.3%, p<0.001) and lagging fetal growth as evidenced by small for gestational age (SGA<10th%) birthweight (44.8 vs 42.1%, p<0.001). After adjusting for coexistent risk in multivariate analysis, SGA birthweight (aRR 1.2, CI 1.1-1.3), Black race (aRR 1.2, CI 1.1-1.3), and chronic HTN (aRR 1.3, CI 1.1-1.5) were associated with early stillbirth. Factors associated with late stillbirth (≥32 wks) included pregestational diabetes (aRR 1.7, CI 1.4-2.1) and gestational diabetes (aRR 3.1, CI 2.6-3.7). Women with late stillbirths were more likely to be delivered via cesarean, (26.9 vs 8.7%, p<0.001; aRR 3.5, CI 3.2-3.9) and to have a fetal autopsy performed. More than 6 out of 10 stillbirths in this study occurred < 32 weeks of gestation, before ANFS is typically initiated as recommended by ACOG. Among identifiable risk factors, CHTN, Black race, and lagging fetal growth as evidenced by birthweight were associated with higher risk of stillbirth before 32 weeks’ gestation. Earlier ANFS may be warranted at earlier gestational ages in certain “at risk” women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)