Getahun Darios, Ananth Cande V, Kinzler Wendy L
Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-1977, USA.
Am J Obstet Gynecol. 2007 Jun;196(6):499-507. doi: 10.1016/j.ajog.2006.09.017.
To examine disparities in risk factors for stillbirths and its occurrence in the antepartum versus intrapartum periods. A population-based, cross-sectional study using data on women that delivered singleton births between 20 and 43 weeks in Missouri (1989-1997) was conducted (n = 626,883). Hazard ratios and 95% confidence intervals were derived from regression models and population attributable fractions were estimated to examine the impact of risk factors on stillbirth. Among African Americans, risks of antepartum and intrapartum stillbirth were 5.6 and 1.1 per 1,000 singleton births, respectively; risks among whites were 3.4 and 0.5 per 1,000 births, respectively. Maternal age > or = 35 years, lack of prenatal care, prepregnancy body mass index (BMI) > or = 30 kg/m2, and prior preterm or small-for-gestational age birth were significantly associated with increased risk for antepartum stillbirth among whites, but not African Americans. BMI < or = 18.5 kg/m2 was associated with antepartum and intrapartum stillbirth among African Americans, but not whites. The presence of any congenital anomaly, abruption, and cord complications were associated with antepartum stillbirth in both races. Premature rupture of membranes was associated with intrapartum stillbirth among whites and African Americans, but intrapartum fever was associated with intrapartum stillbirth among African Americans. These risk factors were implicated in 54.9% and 19.7% of antepartum and intrapartum stillbirths, respectively, among African American women, and in a respective 46.6% and 11.9% among white women. Considerable heterogeneity in risk factors between antepartum and intrapartum stillbirths is evident. Knowledge on timing of stillbirth specific risk factors may help clinicians in decreasing antepartum and intrapartum stillbirth risks through monitoring and timely intervention.
研究死产危险因素的差异及其在产前与产时的发生情况。利用密苏里州（1989 - 1997年）20至43周单胎分娩妇女的数据进行了一项基于人群的横断面研究（n = 626,883）。从回归模型得出风险比和95%置信区间，并估计人群归因分数以研究危险因素对死产的影响。在非裔美国人中，产前和产时死产风险分别为每1000例单胎分娩5.6例和1.1例；白人中的风险分别为每1000例分娩3.4例和0.5例。母亲年龄≥35岁、缺乏产前护理、孕前体重指数（BMI）≥30 kg/m²以及既往早产或小于胎龄儿出生与白人产前死产风险增加显著相关，但与非裔美国人无关。BMI≤18.5 kg/m²与非裔美国人的产前和产时死产相关，但与白人无关。任何先天性异常、胎盘早剥和脐带并发症在两个种族中均与产前死产相关。胎膜早破与白人和非裔美国人的产时死产相关，但产时发热与非裔美国人的产时死产相关。这些危险因素分别涉及非裔美国妇女产前和产时死产的54.9%和19.7%，以及白人妇女的46.6%和11.9%。产前和产时死产危险因素之间存在明显的异质性。了解死产特定危险因素的发生时间可能有助于临床医生通过监测和及时干预降低产前和产时死产风险。
