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AJP Rep 2016; 06(03): e287-e298
DOI: 10.1055/s-0036-1587322
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Influence of Birthweight on the Prospective Stillbirth Risk in the Third Trimester: A Cross-Sectional Cohort Study

Stephen Contag
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
,
Clayton Brown
2   Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
,
Sarah Crimmins
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
,
Katherine Goetzinger
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

30 March 2016

01 July 2016

Publication Date:
17 August 2016 (online)

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Abstract

Objective  The objective of this study was to determine the effect of birthweight on prospective stillbirth risk.

Methods Cross-sectional study of singleton births in the United States from 2010 to 2012 from 32 through 42 weeks was conducted. Stillbirth risk was stratified by birthweight and gestational age adjusted for time from death to delivery. The primary outcome was the prospective stillbirth risk for each birthweight category. Student t-test was used for continuous data, chi-square to compare categorical data. Binomial proportions were used to derive prospective and cumulative risks. Cox proportional hazards regression with log–rank test comparison for heterogeneity was used to compare birthweight categories and derive hazard ratios.

Results There was an increase in the risk for stillbirth as birthweight diverged from the reference group. At 40 weeks adjusted gestational age, stillbirth rate per 10,000 births for the bottom (6.17, 95% CI: 7.47–4.87) and top (2.37, 95%CI: 3.1–1.65) 5th centiles of birthweight conveyed the highest risk. Hazard ratios (HR) after adjusting for covariates were: 1.55 (1.73–1.4) <5th centile and 2.2 (2.43–1.99) > 95th centile (p < 0.001).

Conclusion Stillbirth risk increases as birthweight departs from the mean. Birthweight below the 5th and above the 95th centile conveyed a significantly increased risk for stillbirth which was most noticeable after 37 weeks.

Keywords

third trimester - birthweight - stillbirth - growth restriction - prospective risk

Funding

None.


 

  • References

  • 1 Goldenberg RL, McClure EM, Bhutta ZA , et al; Lancet's Stillbirths Series steering committee. Stillbirths: the vision for 2020. Lancet 2011; 377 (9779) 1798-1805
    CrossrefPubMedSearch in Google Scholar
  • 2 Darmstadt GL, Kinney MV, Chopra M , et al; Lancet Every Newborn Study Group. Who has been caring for the baby?. Lancet 2014; 384 (9938) 174-188
    CrossrefPubMedSearch in Google Scholar
  • 3 Ananth CV, Joseph KS, Oyelese Y, Demissie K, Vintzileos AM. Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstet Gynecol 2005; 105 (5 Pt 1) 1084-1091
    CrossrefPubMedSearch in Google Scholar
  • 4 Gyamfi-Bannerman C, Ananth CV. Trends in spontaneous and indicated preterm delivery among singleton gestations in the United States, 2005-2012. Obstet Gynecol 2014; 124 (6) 1069-1074
    CrossrefPubMedSearch in Google Scholar
  • 5 Lees CC, Marlow N, van Wassenaer-Leemhuis A , et al; TRUFFLE study group. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet 2015; 385 (9983) 2162-2172
    CrossrefPubMedSearch in Google Scholar
  • 6 Clausson B, Gardosi J, Francis A, Cnattingius S. Perinatal outcome in SGA births defined by customised versus population-based birthweight standards. BJOG 2001; 108 (8) 830-834
    CrossrefPubMedSearch in Google Scholar
  • 7 Getahun D, Ananth CV, Kinzler WL. Risk factors for antepartum and intrapartum stillbirth: a population-based study. Am J Obstet Gynecol 2007; 196 (6) 499-507
    CrossrefPubMedSearch in Google Scholar
  • 8 Malhotra A, Yahya Z, Sasi A , et al. Does fetal growth restriction lead to increased brain injury as detected by neonatal cranial ultrasound in premature infants?. J Paediatr Child Health 2015; 51 (11) 1103-1108
    CrossrefPubMedSearch in Google Scholar
  • 9 Murray E, Fernandes M, Fazel M, Kennedy SH, Villar J, Stein A. Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review. BJOG 2015; 122 (8) 1062-1072
    CrossrefPubMedSearch in Google Scholar
  • 10 Pilliod RA, Cheng YW, Snowden JM, Doss AE, Caughey AB. The risk of intrauterine fetal death in the small-for-gestational-age fetus. Am J Obstet Gynecol 2012; 207 (4) 318.e1-318.e6
    CrossrefPubMedSearch in Google Scholar
  • 11 Bukowski R, Hansen NI, Willinger M , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network. Fetal growth and risk of stillbirth: a population-based case-control study. PLoS Med 2014; 11 (4) e1001633
    CrossrefPubMedSearch in Google Scholar
  • 12 Moraitis AA, Wood AM, Fleming M, Smith GC. Birth weight percentile and the risk of term perinatal death. Obstet Gynecol 2014; 124 (2 Pt 1) 274-283
    CrossrefPubMedSearch in Google Scholar
  • 13 Vasak B, Koenen SV, Koster MP , et al. Human fetal growth is constrained below optimal for perinatal survival. Ultrasound Obstet Gynecol 2015; 45 (2) 162-167
    CrossrefPubMedSearch in Google Scholar
  • 14 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1) 323-333
    CrossrefPubMedSearch in Google Scholar
  • 15 Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol 2011; 204 (4) 288-300
    CrossrefPubMedSearch in Google Scholar
  • 16 Hecher K, Bilardo CM, Stigter RH , et al. Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol 2001; 18 (6) 564-570
    CrossrefPubMedSearch in Google Scholar
  • 17 Romero R, Kalache KD, Kadar N. Timing the delivery of the preterm severely growth-restricted fetus: venous Doppler, cardiotocography or the biophysical profile?. Ultrasound Obstet Gynecol 2002; 19 (2) 118-121
    CrossrefPubMedSearch in Google Scholar
  • 18 Turan OM, Turan S, Gungor S , et al. Progression of Doppler abnormalities in intrauterine growth restriction. Ultrasound Obstet Gynecol 2008; 32 (2) 160-167
    CrossrefPubMedSearch in Google Scholar
  • 19 Crimmins S, Desai A, Block-Abraham D, Berg C, Gembruch U, Baschat AA. A comparison of Doppler and biophysical findings between liveborn and stillborn growth-restricted fetuses. Am J Obstet Gynecol 2014; 211 (6) 669.e1-669.e10
    CrossrefPubMedSearch in Google Scholar
  • 20 MacDorman MF, Reddy UM, Silver RM. Trends in Stillbirth by Gestational Age in the United States, 2006-2012. Obstet Gynecol 2015; 126 (6) 1146-1150
    CrossrefPubMedSearch in Google Scholar
  • 21 Smith GCS. Life-table analysis of the risk of perinatal death at term and post term in singleton pregnancies. Am J Obstet Gynecol 2001; 184 (3) 489-496
    CrossrefPubMedSearch in Google Scholar
  • 22 Smith GC. Re: “A proportional hazards model with time-dependent covariates and time-varying effects for analysis of fetal and infant death”. Am J Epidemiol 2005; 161 (1) 100-101 , author reply 100–101
    PubMedSearch in Google Scholar
  • 23 American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol 2013; 121 (5) 1122-1133
    CrossrefPubMedSearch in Google Scholar
  • 24 Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71 (2) 159-163
    CrossrefPubMedSearch in Google Scholar
  • 25 Resnik R. Intrauterine growth restriction. Obstet Gynecol 2002; 99 (3) 490-496
    CrossrefPubMedSearch in Google Scholar
  • 26 National Center for Health Statistics Rockville, MD. Available at: http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm . Last accessed September 10, 2014.
    PubMed
  • 27 Martin JA, Wilson EC, Osterman MJ, Saadi EW, Sutton SR, Hamilton BE. Assessing the quality of medical and health data from the 2003 birth certificate revision: results from two states. Natl Vital Stat Rep. 2013; Jul 22; 62 (2) 1-19
    PubMedSearch in Google Scholar
  • 28 Duryea EL, McIntire DD, Leveno KJ. The rate of preterm birth in the United States is affected by the method of gestational age assignment. Am J Obstet Gynecol 2015; 213 (2) 231.e1-231.e5
    CrossrefPubMedSearch in Google Scholar
  • 29 Conway DL, Hansen NI, Dudley DJ , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network. An algorithm for the estimation of gestational age at the time of fetal death. Paediatr Perinat Epidemiol 2013; 27 (2) 145-157
    CrossrefPubMedSearch in Google Scholar
  • 30 Altman DG, Chitty LS. Design and analysis of studies to derive charts of fetal size. Ultrasound Obstet Gynecol 1993; 3 (6) 378-384
    CrossrefPubMedSearch in Google Scholar
  • 31 Altman DG, Chitty LS. Charts of fetal size: 1. Methodology. Br J Obstet Gynaecol 1994; 101 (1) 29-34
    PubMedSearch in Google Scholar
  • 32 Royston P, Wright EM. How to construct ‘normal ranges’ for fetal variables. Ultrasound Obstet Gynecol 1998; 11 (1) 30-38
    CrossrefPubMedSearch in Google Scholar
  • 33 MacDorman MF, Kirmeyer SE, Wilson EC. Fetal and perinatal mortality, United States, 2006. Natl Vital Stat Rep 2012; Aug 28; 60 (8) 1-22
    PubMedSearch in Google Scholar
  • 34 Yudkin PL, Wood L, Redman CW. Risk of unexplained stillbirth at different gestational ages. Lancet 1987; 1 (8543) 1192-1194
    PubMedSearch in Google Scholar
  • 35 Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet 2003; 362 (9398) 1779-1784
    CrossrefPubMedSearch in Google Scholar
  • 36 K.G. M. Stallard E. Medical Demography: Interaction of Disability Dynamics and Mortality. In: Martin LG, Preston SH, eds, National Research Council (US) Committee on Population: Demography of Aging. Washington, DC: National Academies Press; 1994
    Search in Google Scholar
  • 37 Greenland S, Neutra R. Control of confounding in the assessment of medical technology. Int J Epidemiol 1980; 9 (4) 361-367
    CrossrefPubMedSearch in Google Scholar
  • 38 Macdorman MF, Kirmeyer S. The challenge of fetal mortality. NCHS data brief 2009 (16):1–8. Available at: http://www.cdc.gov/nchs/data/databriefs/db16.pdf Accessed September 15, 2015.
    PubMedSearch in Google Scholar
  • 39 Altman DG, Bland JM. Missing data. BMJ 2007; 334 (7590) 424
    CrossrefPubMedSearch in Google Scholar
  • 40 Society for Research in Child Development. Missing data: What to do with or without them. Monogr Soc Res Child Dev 2006; 71 (3) 42-64
    PubMedSearch in Google Scholar
  • 41 Morales-Roselló J, Khalil A, Morlando M, Papageorghiou A, Bhide A, Thilaganathan B. Changes in fetal Doppler indices as a marker of failure to reach growth potential at term. Ultrasound Obstet Gynecol 2014; 43 (3) 303-310
    CrossrefPubMedSearch in Google Scholar
  • 42 Center for Disease Control and Prevention. Birth edit specifications for the 2003 proposed revision of the United States standard certificate of birth. Available at: http://www.cdc.gov/nchs/data/dvs/birth_edit_specifications.pdf"> Accessed: September 30, 2015
    PubMed
  • 43 Duryea EL, Hawkins JS, McIntire DD, Casey BM, Leveno KJ. A revised birth weight reference for the United States. Obstet Gynecol 2014; 124 (1) 16-22
    CrossrefPubMedSearch in Google Scholar
  • 44 Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ 2013; 346: f108
    CrossrefPubMedSearch in Google Scholar
  • 45 Edmunds SF, Silver RM. Stillbirth reduction efforts and impact on early births. Clin Perinatol 2013; 40 (4) 611-628
    CrossrefPubMedSearch in Google Scholar
  • 46 Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA 2011; 306 (22) 2459-2468
    CrossrefPubMedSearch in Google Scholar
  • 47 Waldenström U, Cnattingius S, Norman M, Schytt E. Advanced Maternal Age and Stillbirth Risk in Nulliparous and Parous Women. Obstet Gynecol 2015; 126 (2) 355-362
    CrossrefPubMedSearch in Google Scholar
  • 48 Darmstadt GL, Shiffman J, Lawn JE. Advancing the newborn and stillbirth global agenda: priorities for the next decade. Arch Dis Child 2015; 100 (Suppl. 01) S13-S18
    CrossrefPubMedSearch in Google Scholar