Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
Obstet Gynecol. 2010 Nov;116(5):1119-26. doi: 10.1097/AOG.0b013e3181f903f8.
To identify possible prepregnancy risk factors for antepartum stillbirth and to determine whether these factors identify women at higher risk for term stillbirth.
This retrospective cohort study of prepregnancy risk factors compared 712 singleton antepartum stillbirths with 174,097 singleton live births at or after 23 weeks of gestation. The risk of term antepartum stillbirth then was assessed in a subset of 155,629 singleton pregnancies.
In adjusted multivariable analyses, African-American race, Hispanic ethnicity, maternal age 35 years or older, nulliparity, prepregnancy body mass index (BMI) 30 or higher, preexisting diabetes, chronic hypertension, smoking, and alcohol use were independently associated with stillbirth. Prior cesarean delivery and history of preterm birth were associated with increased stillbirth risk in multiparous women. The risk of a term stillbirth for women who were white, 25-29 years old, normal weight, multiparous, no chronic hypertension, and no preexisting diabetes was 0.8 per 1,000. Term stillbirth risk increased with the following conditions: preexisting diabetes (3.1 per 1,000), chronic hypertension (1.7 per 1,000), African-American race (1.8 per 1,000), maternal age 35 years or older (1.3 per 1,000), BMI 30 or higher (1 per 1,000), and nulliparity (0.9 per 1,000).
There are multiple independent risk factors for antepartum stillbirth. However, the value of individual risk factors of race, parity, advanced maternal age (35-39 years old), and BMI to predict term stillbirth is poor. Our results do not support routine antenatal surveillance for any of these risk factors when present in isolation.
II.
确定产前死胎的可能孕前危险因素，并确定这些因素是否能识别出更高风险的足月死胎的女性。
这项关于孕前危险因素的回顾性队列研究比较了 712 例单胎产前死胎和 174097 例 23 周或以上胎龄的单胎活产。然后，在 155629 例单胎妊娠中评估了足月产前死胎的风险。
在调整后的多变量分析中，非裔美国人、西班牙裔、母亲年龄 35 岁或以上、未婚、孕前体重指数（BMI）30 或更高、糖尿病、慢性高血压、吸烟和饮酒与死胎独立相关。既往剖宫产和早产史与多产妇的死胎风险增加相关。对于白人、25-29 岁、正常体重、多产妇、无慢性高血压和无糖尿病的女性，每 1000 例中发生足月死胎的风险为 0.8 例。以下情况的足月死胎风险增加：糖尿病（3.1 例/1000）、慢性高血压（1.7 例/1000）、非裔美国人（1.8 例/1000）、母亲年龄 35 岁或以上（1.3 例/1000）、BMI 30 或更高（1 例/1000）、未婚（0.9 例/1000）。
有多种独立的产前死胎危险因素。然而，种族、产次、高龄（35-39 岁）和 BMI 等个别危险因素预测足月死胎的价值较差。当这些危险因素单独存在时，我们的结果不支持常规产前监测。
II 级。
