Risk Of Late Fetal Death Research Articles

Pre-pregnancy Body Mass Index and the Risk of Adverse Pregnancy Outcome in Two Thousand Type 2 Diabetes Mellitus Bangladeshi Women

Background: The aim of the present study were to evaluate the frequency of maternal complications and adverse fetal outcomes in a group of singleton pregnant women with type 2 diabetes mellitus to compare the outcome in three groups (lean, normal and overweight). Materials and Methods: The women were categorized into three groups: lean 25.0-29.9 kg/m2. The effect of pre-pregnancy BMI was analyzed by comparing the frequencies of various outcomes in three BMI groups. The results were expressed as odds ratio (ORs) and the corresponding 95% confidence intervals (CIs) & p values. Results: The risk of late fetal death was consistently increasing with BMI (ORs were 1.2 (0.9-1.7), 1.6 (1.1-2.3) & 2.6 (1.7-3.8) for lean, normal & overweight respectively). The risk of early neonatal death was also higher among women with higher BMI (ORs was 1.6 (1.1-2.3) for overweight). The rate of preeclampsia is higher among women with lean and overweight BMI in compares to normal BMI (the values were 2.5%, 1.8%, & 7.0% for lean, normal & overweight respectively). Hypertensive disorders was also more common among lean (3.8%) and overweight (3.6%) compared to normal (1.6%). The risk of preterm delivery was significantly increased for overweight group (4.2%) and lean (2.4%), as compare to normal. The risk of SGA was significantly more in lean (2.7%) compared to normal weight (1.5%) & overweight group (1.9%). Conclusion: Pre-pregnancy overweight increases the risk of late fetal death and perinatal mortality.

Hemoglobina materna en la salud perinatal y materna en la altura: implicancias en la región andina

This review analyzes the importance of hemoglobin levels in pregnant women and its implications in pregnancy. It discuss the use of biomass fuel for cooking and the impact on birthweight, maternal hemoglobin levels and the risk of late fetal death, pre-term delivery, and small for gestational age. Furthermore, the need to correct the cut-off points of hemoglobin level to define anemia at high altitudes is addressed. Current evidence suggests that corrections should not be made and iron supplements should be given to pregnant mothers with moderate or severe anemia. It is discussed whether iron supplementation should change its target population from pregnant women to infants aged 6 to 36 months.

Hemoglobina materna en la salud perinatal y materna en la altura: implicancias en la región andina

This review analyzes the importance of hemoglobin levels in pregnant women and its implications in pregnancy. It discuss the use of biomass fuel for cooking and the impact on birthweight, maternal hemoglobin levels and the risk of late fetal death, pre-term delivery, and small for gestational age. Furthermore, the need to correct the cut-off points of hemoglobin level to define anemia at high altitudes is addressed. Current evidence suggests that corrections should not be made and iron supplements should be given to pregnant mothers with moderate or severe anemia. It is discussed whether iron supplementation should change its target population from pregnant women to infants aged 6 to 36 months.

57: Gestational age at elective delivery in twin-to-twin transfusion syndrome (TTTS) treated by laser coagulation and and the risk of late fetal death

Treatment of twin-to-twin transfusion syndrome (TTTS) by fetoscopic selective laser coagulation (FSLC) has improved perinatal outcome. However residual risk of late intrauterine fetal deaths (IUFD) and optimal gestational age (GA) at elective delivery remain controversial. We investigated the risk of IUFD after 28 weeks’ in TTTS cases diagnosed before 26 weeks′ and treated by FSLC.

Advanced Paternal Age and Risk of Fetal Death: A Cohort Study

A possible detrimental paternal age effect on offspring health due to mutations of paternal origin should be reflected in an association between paternal age and fetal loss. The authors used data from a prospective study of 23,821 pregnant women recruited consecutively to the Danish National Birth Cohort from 1997 to 1999 to assess the association between paternal age and fetal death. Fathers of the pregnancies were identified by record linkage to population registers. The paternal age-related risks of fetal death and its components, early and late fetal loss, were estimated using survival analysis. Pregnancies fathered by a man aged 50 or more years (n = 124) had almost twice the risk of ending in a fetal loss compared with pregnancies with younger fathers (hazard ratio = 1.88, 95% confidence interval: 0.93, 3.82), after adjustment for maternal age, reproductive history, and maternal lifestyle during pregnancy. Various approaches to adjustment for potential residual confounding of the relation by maternal age did not affect the relative risk estimates. The paternal age-related risk of late fetal death was higher than the risk of early fetal death and started to increase from the age of 45 years. It should, however, be interpreted cautiously because of the restricted number of fetal deaths.

Paternal age over 40 years: the "amber light" in the reproductive life of men?

In industrialized countries, many couples are choosing to delay childbearing, and the proportion of couples having children after age 30–35 years has increased. This has highlighted the effect of age on reproductive failure (van Balen et al, 1997). The effects of maternal age have been thoroughly investigated in the past few decades, and a major effect of maternal age over 35 years has been demonstrated on infertility, ectopic pregnancy, and miscarriage (van Noord-Zaadstra et al, 1991; van Balen et al, 1997; Nybo Andersen et al, 2000). In contrast, little attention has been paid to the possible effects of paternal age. Most studies that have dealt with this factor have focused on changes in sperm characteristics with age, and physicians have tried to set an upper age limit for sperm donors. The American Society for Reproductive Medicine (1998) and the British Andrology Society (1999) have fixed the upper age limit for sperm donation at 40 years old on the basis of the increased risk of genetic abnormalities in children of older fathers (Bordson and Leonardo, 1991). In discussions of the effects of paternal age with a view toward setting age limits for sperm donors, the possibility that paternal age affects the likelihood of reproductive failure was not considered. In other respects, some demographic studies have analyzed the effects of paternal age on effective fecundity, which is the probability of initiating a pregnancy leading to a live birth (Anderson, 1975; Mineau and Trussell, 1982; Goldman and Montgomery, 1989; Strassmann and Warner, 1998). These studies, based on large data sets from populations not using birth control methods, showed

Mutations in coagulation factors in women with unexplained late fetal loss.

Factor V and prothrombin-gene mutations are independent risk factors for venous thrombosis; it is debated whether a mutation in the gene encoding methylenetetrahydrofolate reductase, an enzyme involved in homocysteine metabolism, also increases the risk of venous thrombosis. Whether any of these mutations is associated with an increased risk of late fetal death is not known. We studied 67 women with a first episode of unexplained late fetal loss (fetal death after 20 weeks or more of gestation) and 232 women who had had one or more normal pregnancies and no late fetal losses. All the women were tested for the presence of three gene mutations. Women with other thrombophilic conditions were excluded from the study. Eleven of the 67 women with late fetal loss (16 percent) and 13 of the 232 control women (6 percent) had either the factor V or the prothrombin mutation. The relative risks of late fetal loss in carriers of the factor V and prothrombin mutations were 3.2 (95 percent confidence interval, 1.0 to 10.9) and 3.3 (95 percent confidence interval, 1.1 to 10.3), respectively. Thirteen percent of the women whose fetuses died and 20 percent of the control women were homozygous for the mutation in the methylenetetrahydrofolate reductase gene (relative risk, 0.8; 95 percent confidence interval, 0.5 to 1.2). Both the factor V and the prothrombin mutations are associated with an approximate tripling of the risk of late fetal loss.

Teenage Pregnancies and Risk of Late Fetal Death and Infant Mortality

Objective To estimate the effect of low maternal age on late fetal death and infant mortality and to estimate the extent of any increase in infant mortality attributable to higher rates of preterm birth among teenagers. Design Population-based cohort study. Setting Births recorded in the nationwide Swedish Medical Birth Registry. Population All single births to nulliparous women aged 13–24 years (n= 320,174) during 1973–1989. Methods Using information recorded in the medical birth registry, linked to a national education register, the effect of low maternal age on adverse outcomes was estimated using logistic regression analysis. Main outcome measures Late fetal death, neonatal and postneonatal mortality and preterm birth. Results Compared with mothers aged 2CL24 years, adjusted risks of neonatal and postneonatal mortality were significantly increased among mothers aged 13–15 years (odds ratios = 2.7 and 2.6, respectively) and among those aged 16–17 years (odds ratios = 1.4 and 2.0, respectively), while mothers aged 18–19 years had a significant increase in risk of postneonatal mortality only (odds ratio = 1.4). Rates of very preterm birth (≤ 32 weeks), according to maternal age, were: 13–15 years, 5.9%; 16–17 years, 2.5%; 18–19 years, 1.7%; and 20–24 years, 1.1%. The high rates of very preterm birth among young teenagers almost entirely explained the increased risk of neonatal mortality in this group. Conclusions The increased risks of neonatal and postneonatal mortality among young teenagers may be related to biological immaturity. The increase in risk of neonatal mortality is largely explained by increased rates of very preterm birth.

The changing panorama of late fetal death in Sweden between 1984 and 1991

During the last decade there has been a significant reduction in early neonatal mortality. The rate of late fetal death, however, has not changed significantly despite improvements in antenatal care. This study evaluated the years 1984 and 1991 as to possible changes in well known risk factors for late fetal death. We studied all single births during 1984 and 1991 recorded in the Swedish Medical Birth Register. In 1984, there were 94,270 births; of these, 381 were late fetal deaths. In 1991, there were 124,201 births and 464 late fetal deaths. The risk factors analyzed included maternal age, parity, smoking, birth weight, birth weight deviation, plurality, hypertension, diabetes, placental complications and previous late fetal death. Some of these variables were assessed in a cohort design and others in a case-control design. The small reduction in the late fetal death rate between 1984 and 1991 (4.0/1000 vs. 3.7/1000 births) may be explained by changes in maternal age and parity. However, it seems more likely that changes have occurred in the various risk factors, but the net result did not affect the late fetal death rate. Although the number of mothers who smoked decreased from 30% to 24%, this habit increased as a risk factor, especially when it was >=10 cig/day (odds ratio 1.24 vs. 1.97). Infants <2500g showed a significant decrease in the risk of late fetal death. No significant change in the latter risk was found among infants small for gestational age. Demographic changes may entirely explain the small decrease in late fetal death rate between 1984 and 1991. Despite all the improvements in the care of pregnant women between these years, the net gain, in terms of a decreasing number of late fetal deaths, is small, which most likely is due to shifts in the fetal death risks between the risk factors. Further significant decreases in the number of late fetal deaths may be difficult to obtain through improvements in the Maternal Health Care Service.

Teenage pregnancies and risk of late fetal death and infant mortality.

To estimate the effect of low maternal age on late fetal death and infant mortality and to estimate the extent of any increase in infant mortality attributable to higher rates of preterm birth among teenagers. Population-based cohort study. Births recorded in the nationwide Swedish Medical Birth Registry. All single births to nulliparous women aged 13-24 years (n = 320,174) during 1973-1989. Using information recorded in the medical birth registry, linked to a national education register, the effect of low maternal age on adverse outcomes was estimated using logistic regression analysis. Late fetal death, neonatal and postneonatal mortality and preterm birth. Compared with mothers aged 20-24 years, adjusted risks of neonatal and postneonatal mortality were significantly increased among mothers aged 13-15 years (odds ratios = 2.7 and 2.6, respectively) and among those aged 16-17 years (odds ratios = 1.4 and 2.0, respectively), while mothers aged 18-19 years had a significant increase in risk of postneonatal mortality only (odds ratio = 1.4). Rates of very preterm birth (< or = 32 weeks), according to maternal age, were: 13-15 years, 5.9%; 16-17 years, 2.5%; 18-19 years, 1.7%; and 20-24 years, 1.1%. The high rates of very preterm birth among young teenagers almost entirely explained the increased risk of neonatal mortality in this group. The increased risks of neonatal and postneonatal mortality among young teenagers may be related to biological immaturity. The increase in risk of neonatal mortality is largely explained by increased rates of very preterm birth.

Some small for gestational age fetuses have higher risk of late fetal death than others

Some small for gestational age fetuses have higher risk of late fetal death than others

Determinants of Poor Pregnancy Outcomes Among Teenagers in Sweden

In Brief Objective To study pregnancy outcomes among teenagers and to determine whether age-related increases in risk are due to differences in socioeconomic conditions, maternal smoking, or anthropometric status. Methods All single births during 1990–1991 to mothers aged less than 25 years recorded in the Swedish Medical Birth Registry were studied (n = 62,433). The pregnancy outcomes analyzed were late fetal death, infant mortality, preterm birth, low birth weight, small for gestational age, and low Apgar scores. Information on maternal age, parity, family situation, maternal smoking, maternal height, and weight gain during pregnancy was recorded in the Medical Birth Registry. Information on socioeconomic characteristics was obtained from the Population Census. Logistic regression analysis was used to define the determinants of the adverse outcomes among teenagers. Results Compared with women aged 20–24 years, girls of 17 years or less were at higher risk for preterm birth (odds ratio [OR] 1.6), and this increased risk remained essentially unchanged after controlling for major confounding factors (OR 1.5). Teenagers also had a crude 50% higher risk of late fetal death and infant mortality, but this risk was reduced after controlling for the effect of socioeconomic characteristics (adjusted OR 1.2). Conclusions The increase in risk of late fetal death and infant mortality associated with low maternal age is substantially an effect of teenagers' poorer socioeconomic situation. However, the increase in preterm birth among younger teenagers suggests that young maternal age may be a biologic risk factor for preterm birth. Teenagers are at increased risk for poor pregnancy outcomes, and the increase in fetal and infant mortality is substantially related to poorer socioeconomic conditions.

Determinants of poor pregnancy outcomes among teenagers in Sweden

To study pregnancy outcomes among teenagers and to determine whether age-related increases in risk are due to differences in socioeconomic conditions, maternal smoking, or anthropometric status. All single births during 1990-1991 to mothers aged less than 25 years recorded in the Swedish Medical Birth Registry were studied (n = 62,433). The pregnancy outcomes analyzed were late fetal death, infant mortality, preterm birth, low birth weight, small for gestational age, and low Apgar scores. Information on maternal age, parity, family situation, maternal smoking, maternal height, and weight gain during pregnancy was recorded in the Medical Birth Registry. Information on socioeconomic characteristics was obtained from the Population Census. Logistic regression analysis was used to define the determinants of the adverse outcomes among teenagers. Compared with women aged 20-24 years, girls of 17 years or less were at higher risk for preterm birth (odds ratio [OR] 1.6), and this increased risk remained essentially unchanged after controlling for major confounding factors (OR 1.5). Teenagers also had a crude 50% higher risk of late fetal death and infant mortality, but this risk was reduced after controlling for the effect of socioeconomic characteristics (adjusted OR 1.2). The increase in risk of late fetal death and infant mortality associated with low maternal age is substantially an effect of teenagers' poorer socioeconomic situation. However, the increase in preterm birth among younger teenagers suggests that young maternal age may be a biologic risk factor for preterm birth.

Risk of Late Fetal Death, Preterm Birth Increases in Women 30 and Older

Risk of Late Fetal Death, Preterm Birth Increases in Women 30 and Older

Birth Intervals and Perinatal Health: An Investigation of Three Hypotheses

This analysis uses data from Hungary, Sweden and the United States to investigate the factors contributing to the high health risks observed among infants born within 12 months of the preceding birth. Three hypotheses for poor perinatal health are explored: confounding by prematurity, selection of high-risk mothers into short birth intervals and maternal depletion. Results show that prematurity accounts for the greatest share of the excess risks associated with closely spaced births, and for virtually all of the excess risk of late fetal death. After the confounding effects of prematurity are controlled for, the study finds that infants conceived within a few months of the preceding birth remain at higher-than-average risk of low birth weight, preterm birth and neonatal death. The results suggest that avoidance of birth intervals of less than two years could be expected to effect a 5-10 percent decreased risk of low birth weight and neonatal death.

Cigarette smoking as risk factor for late fetal and early neonatal death.

Risk factors for late fetal death and early neonatal mortality were examined in a population based prospective study. Practically all Swedish births between 1983 and 1985 were included, 281,808 births in all. The overall rates of late fetal death and early neonatal mortality were 3.5 and 3.1 per 1000, respectively. About 30% of the pregnant women were recorded as being daily smokers. Logistic regression analyses showed significant relative risks for late fetal death for high maternal age (1.4), nulliparity (1.4), multiparity (greater than or equal to 2) (1.3), smoking (1.4), and multiple births (2.8). Significant relative risks for early neonatal mortality were found for multiple births (4.9) and smoking (1.2). Smokers aged under 35 faced a relative risk of late fetal death ranging from 1.1 to 1.6, while the risk for late fetal death was doubled if the mothers were aged 35 years or more and smoked. In countries like Sweden, where maternal cigarette smoking is prevalent, smoking may be the most important preventable risk factor for late fetal death.

Influence of age, birth order and reproductive compensation on stillbirth ratios.

SummaryThis analysis was planned to produce an estimate of the effects of maternal ageing on the risk of stillbirth which would not be confounded by other biological and socio-economic factors. The basic comparison is between late fetal death ratios in second and third births for all women who experienced third single births in California in 1968. The analysis leads to the conclusion that women who experience late fetal deaths initiate more subsequent pregnancies and after shorter intervals than do women who have live births. A sharply lower risk of late fetal death for third birth than for second was found to mask age effects. It is suggested that this reduction in risk reflects the effects of successful diagnosis and treatment of conditions which produce high rates of pregnancy loss.