Stillbirths : Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd..
OBJECTIVE: To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types'.
DESIGN: Population-based multi-country analyses.
SETTING: Births collected through routine data systems in 13 countries.
SAMPLE: 125 419 255 total births from 22+0 to 44+6 weeks' gestation identified from 2000 to 2020.
METHODS: We included 635 107 stillbirths from 22+0 weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37+0 weeks versus term, T, ≥37+0 weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards.
MAIN OUTCOME MEASURES: Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types.
RESULTS: 635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22+0 weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age.
CONCLUSIONS: In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
BJOG : an international journal of obstetrics and gynaecology - (2023) vom: 29. Nov. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Okwaraji, Yemisrach B [VerfasserIn] |
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| Links: |
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| Themen: |
Gestational age |
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| Anmerkungen: |
Date Revised 29.11.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1111/1471-0528.17653 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM365094390 |
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| 100 | 1 | |a Okwaraji, Yemisrach B |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Stillbirths |b Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020 |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 29.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. | ||
| 520 | |a OBJECTIVE: To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types' | ||
| 520 | |a DESIGN: Population-based multi-country analyses | ||
| 520 | |a SETTING: Births collected through routine data systems in 13 countries | ||
| 520 | |a SAMPLE: 125 419 255 total births from 22+0 to 44+6 weeks' gestation identified from 2000 to 2020 | ||
| 520 | |a METHODS: We included 635 107 stillbirths from 22+0 weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37+0 weeks versus term, T, ≥37+0 weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards | ||
| 520 | |a MAIN OUTCOME MEASURES: Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types | ||
| 520 | |a RESULTS: 635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22+0 weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age | ||
| 520 | |a CONCLUSIONS: In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA | ||
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| 700 | 0 | |a National Vulnerable Newborn Collaborative Group for Stillbirths |e verfasserin |4 aut | |
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| 700 | 1 | |a Gibbons, Luz |e investigator |4 oth | |
| 700 | 1 | |a Guevel, Carlos |e investigator |4 oth | |
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| 700 | 1 | |a Horváth-Puhó, Erzsébet |e investigator |4 oth | |
| 700 | 1 | |a Sørensen, Henrik T |e investigator |4 oth | |
| 700 | 1 | |a Sakkeus, Luule |e investigator |4 oth | |
| 700 | 1 | |a Abuladze, Liili |e investigator |4 oth | |
| 700 | 1 | |a Yunis, Khalid A |e investigator |4 oth | |
| 700 | 1 | |a Al Bizri, Ayah |e investigator |4 oth | |
| 700 | 1 | |a Nakad, Pascale |e investigator |4 oth | |
| 700 | 1 | |a Karalasingam, Shamala |e investigator |4 oth | |
| 700 | 1 | |a Ravichandran, J |e investigator |4 oth | |
| 700 | 1 | |a Jeganathan, R |e investigator |4 oth | |
| 700 | 1 | |a Baharum, Nurakman Binti |e investigator |4 oth | |
| 700 | 1 | |a Suárez-Idueta, Lorena |e investigator |4 oth | |
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| 700 | 1 | |a Roldan, Jesus Felipe Gonzalez |e investigator |4 oth | |
| 700 | 1 | |a Alvarez, Sonia Lopez |e investigator |4 oth | |
| 700 | 1 | |a Broeders, Lisa |e investigator |4 oth | |
| 700 | 1 | |a van Dijk, Aimée E |e investigator |4 oth | |
| 700 | 1 | |a Alyafei, Fawzia |e investigator |4 oth | |
| 700 | 1 | |a AlQubaisi, Mai |e investigator |4 oth | |
| 700 | 1 | |a Olukade, Tawa O |e investigator |4 oth | |
| 700 | 1 | |a Ali, Hamdy A |e investigator |4 oth | |
| 700 | 1 | |a Alturk, Mohamad Rami |e investigator |4 oth | |
| 700 | 1 | |a Razaz, Neda |e investigator |4 oth | |
| 700 | 1 | |a Söderling, Jonas |e investigator |4 oth | |
| 700 | 1 | |a Smith, Lucy K |e investigator |4 oth | |
| 700 | 1 | |a Manktelow, Bradley N |e investigator |4 oth | |
| 700 | 1 | |a Matthews, Ruth J |e investigator |4 oth | |
| 700 | 1 | |a Draper, Elizabeth |e investigator |4 oth | |
| 700 | 1 | |a Fenton, Alan |e investigator |4 oth | |
| 700 | 1 | |a Kurinczuk, Jennifer J |e investigator |4 oth | |
| 700 | 1 | |a Wood, Rachael |e investigator |4 oth | |
| 700 | 1 | |a Davis, Celina |e investigator |4 oth | |
| 700 | 1 | |a Monteath, Kirsten |e investigator |4 oth | |
| 700 | 1 | |a Clarke, Samantha |e investigator |4 oth | |
| 700 | 1 | |a Pereyra, Isabel |e investigator |4 oth | |
| 700 | 1 | |a Pravia, Gabriella |e investigator |4 oth | |
| 700 | 1 | |a Lisonkova, Sarka |e investigator |4 oth | |
| 700 | 1 | |a Wen, Qi |e investigator |4 oth | |
| 700 | 1 | |a Lawn, Joy E |e investigator |4 oth | |
| 700 | 1 | |a Blencowe, Hannah |e investigator |4 oth | |
| 700 | 1 | |a Ohuma, Eric |e investigator |4 oth | |
| 700 | 1 | |a Okwaraji, Yemi |e investigator |4 oth | |
| 700 | 1 | |a Yargawa, Judith |e investigator |4 oth | |
| 700 | 1 | |a Bradley, Ellen |e investigator |4 oth | |
| 700 | 1 | |a Black, Robert |e investigator |4 oth | |
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